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Remote Rn Case Review Jobs in Appleton, WI (NOW HIRING)

Network Health WI

RN Care Manager

Menasha, WI · On-site +1

The Registered Nurse Care Manager provides case management services that are member-centric and ... Review results from medical or behavioral tests and procedures and updates care plan to reflect ...

Network Health

RN Care Manager

Menasha, WI · Remote

The Registered Nurse Care Manager provides case management services that are member-centric and ... Review results from medical or behavioral tests and procedures and updates care plan to reflect ...

Network Health, Inc

RN Care Manager

Menasha, WI · Remote

The Registered Nurse Care Manager provides case management services that are member-centric and ... Review results from medical or behavioral tests and procedures and updates care plan to reflect ...

Bellin

RN | Virtual Nursing (Onsite)

Green Bay, WI · On-site +1

The Virtual Registered Nurse (VRN) will manage and deliver remote patient care in an acute setting. As an integral part of the patient care team, the VRN collaborates and communicates effectively ...

State of Wisconsin

Licensed Practical Nurse

Green Bay, WI · On-site +1

$38.59/hr

The LPN is responsible for performing duties assigned by the registered nurse including assisting ... This position is not eligible for remote work. Shifts: (0.75 FTE) Dodge Correctional Institution ...

Katch

Recovery Specialist

Green Bay, WI · On-site +1

Participate in case reviews and strategy discussions * Mentor other team members in subrogation ... Remote work options available for many roles * Flexible schedules in select positions For more ...

micro1 AI

Cheminformatics Specialist - Remote

Green Bay, WI · On-site +1

$90 - $120/hr

Remote micro1 is engaging Computational Biology Experts to contribute their advanced scientific ... Develop and review problem sets, case studies, or scenarios based on real-world medicinal chemistry ...

State of Wisconsin

Nurse Clinician 3 - 80%

Oshkosh, WI · On-site +1

$46 - $57.23/hr

The rate offered within this range will relate to years of licensure/credentialing as a registered ... Job Details This position is not eligible for remote work and will work on site. This position is ...

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Remote Rn Case Review information

See Appleton, WI salary details

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$46

$78

How much do remote rn case review jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for remote rn case review in Appleton, WI is $46.38, according to ZipRecruiter salary data. Most workers in this role earn between $34.47 and $56.06 per hour, depending on experience, location, and employer.

What is the difference between Remote Rn Case Review vs Remote Rn Utilization Review?

AspectRemote Rn Case ReviewRemote Rn Utilization Review
CredentialsRegistered Nurse (RN), licensure, case review certificationsRegistered Nurse (RN), licensure, utilization review certifications
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, healthcare settings, insurance companies
Employer & IndustryHospitals, insurance firms, healthcare providersInsurance companies, healthcare management organizations

Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.

What are popular job titles related to Remote Rn Case Review jobs in Appleton, WI? For Remote Rn Case Review jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Remote Rn Case Review jobs in Appleton, WI look for? The top searched job categories for Remote Rn Case Review jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Remote Rn Case Review jobs? Cities near Appleton, WI with the most Remote Rn Case Review job openings:
Remote Rn Case Review jobs near you

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Re-posted yesterday

Job description

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks.
Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday
Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:
  • Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
  • Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
  • Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
  • Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
  • Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
  • Collaborate with other NH departments to develop interdepartmental operational processes
  • Support Utilization Management department programs and goals through active participation
  • Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
  • Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
  • Evaluate cases for cost savings/quality improvement potential
  • Other duties and responsibilities as assigned

Job Requirements:
  • Bachelor of Science in Nursing, preferred
  • Associate Degree in Nursing, required
  • Current registered nurse licensure in Wisconsin required
  • Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
  • Experience in insurance, managed care and utilization management preferred

Network Health is an Equal Opportunity Employer
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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