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Remote Utilization Management Jobs in Wisconsin (NOW HIRING)

Pharmacy Careers

Appeals Pharmacist (Remote)

Milwaukee, WI · On-site +1

$56.50 - $68.75/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Madison, WI · On-site +1

$57.75 - $70.25/hr

Prior managed care or utilization management experience preferred - retail and hospital pharmacists ... Many roles offer hybrid or fully remote options. * Rewards: Competitive salary, comprehensive ...

Deloitte

Epic Tapestry Specialist

Milwaukee, WI · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Ability to work independently and collaborate as part of a team

Deloitte

Epic Tapestry Consultant

Milwaukee, WI · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Strong desktop skills including Word, Excel, PowerPoint * Work ...

Deloitte

Epic Tapestry Sr Analyst

Milwaukee, WI · On-site +1

Role is remote Preferred * Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Analytical/ Decision Making Responsibilities * Analytical ability to ...

WPS

Appeals Registered Nurse

Madison, WI · On-site +1

$30.50 - $40.25/hr

... Utilization Management/Review, or Appeals preferred. * Basic Medicare knowledge and/or experience preferred. Remote Work Requirements * Wired (ethernet cable) internet connection from your router to ...

WPS Health Solutions

Appeals Registered Nurse

Madison, WI · On-site +1

... Utilization Management/Review, or Appeals preferred. * Basic Medicare knowledge and/or experience preferred. Remote Work Requirements * Wired (ethernet cable) internet connection from your router to ...

UnitedHealth Group

Clinical Appeals RN - Remote

Wausau, WI · Remote

$29 - $52/hr

Utilization Management, pre-authorization, concurrent review, or appeals experience * Proven knowledge of ICD - 10 / CPT coding * Proven knowledge or experience with InterQual * Proven knowledge of ...

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Remote Utilization Management information

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How much do remote utilization management jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for remote utilization management in Wisconsin is $42.68, according to ZipRecruiter salary data. Most workers in this role earn between $33.75 and $48.99 per hour, depending on experience, location, and employer.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Wisconsin? The most popular types of Utilization Management jobs in Wisconsin are:
What are popular job titles related to Remote Utilization Management jobs in Wisconsin? For Remote Utilization Management jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Wisconsin look for? The top searched job categories for Remote Utilization Management jobs in Wisconsin are:
What cities in Wisconsin are hiring for Remote Utilization Management jobs? Cities in Wisconsin with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Wisconsin as of June 2026, with employment types broken down into 84% Full Time, 15% Part Time, and 1% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $88,769 per year, or $42.7 per hour.

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Posted 6 days ago

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 2024 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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