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Remote Utilization Review Manager Jobs in Appleton, WI

Bellin

Manager, Revenue Integrity

Green Bay, WI · On-site +1

Location: 2020 S Webster Ave, Green Bay, WI 54301 | Remote eligibility with occasional travel ... pricing reviews, code set updates, and charge ticket accuracy. * Lead the new service line ...

Cisco

Software Security Lead (Remote)

Appleton, WI · Remote

We act asa strategic partnertoProduct Management, Engineering, and IT and Enterprise Operations ... This lead sets the architecture bar, reviewing and approving secure designs across the portfolio.

Cisco

Software Security Lead (Remote)

Appleton, WI · Remote

We act asa strategic partnertoProduct Management, Engineering, and IT and Enterprise Operations ... This lead sets the architecture bar, reviewing and approving secure designs across the portfolio.

A.O. Smith

National Sales Channel Manager

Appleton, WI · Remote

$144K/yr

... Remote #Appcast ADA Statement & EEO Statement In developing this care was taken to include all ... All reasonable accommodation requests will be reviewed and evaluated on a case-by-case basis. We ...

micro1 AI

Medical Writing Manager

Green Bay, WI · Remote

$50 - $80/hr

Remote micro1 is engaging Medical Writers / Clinical Document Authors to participate in a customer ... Author and review realistic evaluation tasks based on Clinical Study Reports, DSURs, PSURs/PBRERs ...

Faithtechnologies

Project Controls Manager

Menasha, WI · Remote

... REMOTE How Does FTI Give YOU the Chance to Thrive? If you're energized by new challenges, FTI ... You're invited to review the full list of FTI benefits available to regular/full-time team members.

Faith Technologies

Project Controls Manager

Menasha, WI · Remote

... REMOTE How Does FTI Give YOU the Chance to Thrive? If you're energized by new challenges, FTI ... You're invited to review the full list of FTI benefits available to regular/full-time team members.

Faithtechnologies

Project Controls Manager

Appleton, WI · Remote

... REMOTE How Does FTI Give YOU the Chance to Thrive? If you're energized by new challenges, FTI ... You're invited to review the full list of FTI benefits available to regular/full-time team members.

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Appleton, WI

Remote Utilization Review Manager information

See Appleton, WI salary details

$38.1K

$88.8K

$163.4K

How much do remote utilization review manager jobs pay per year?

As of Sep 9, 2026, the average yearly pay for remote utilization review manager in Appleton, WI is $88,802.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,100.00 and $106,800.00 per year, depending on experience, location, and employer.

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a remote utilization review manager?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What are popular job titles related to Remote Utilization Review Manager jobs in Appleton, WI?

For Remote Utilization Review Manager jobs in Appleton, WI, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Manager jobs in Appleton, WI look for?

The top searched job categories for Remote Utilization Review Manager jobs in Appleton, WI are:

What cities near Appleton, WI are hiring for Remote Utilization Review Manager jobs?

Cities near Appleton, WI with the most Remote Utilization Review Manager job openings:

Remote Utilization Review Manager jobs near you

Patient Billing Representative

Green Bay, WI • On-site, Remote

Five Star Solutions
See more jobs at Five Star Solutionsexternal

$14/hr

Full-time

Posted 20 days ago

Job description

Join us as a Patient Billing Specialist, where you'll support patients with payment processing, billing education, insurance verification, and claims-related inquiries. This role delivers empathetic, accurate, and compliant service while navigating healthcare billing systems and policies. Agents perform all payment processing and payment plan functions in addition to advanced billing, insurance, and claims support.
This is a remote position for those that reside in = AL, GA, ID, IA, IN, KS, LA, MI, MS, NV, NC, ND, OH, OK, PA, SC, SD, TX, TN, UT, VA, WV, WI, WY
Qualifications
  • Customer service or call center experience required.
  • Healthcare billing, insurance, or claims experience strongly preferred.
  • Payment processing or financial transaction experience preferred.
  • High school diploma or GED required; additional billing or healthcare education a plus.
  • Technical proficiency with EMR systems and standard computer applications.
  • Ability to work independently in a remote or virtual environment.
  • Must be able to speak, read, write, and understand English.
  • Background check required in accordance with applicable laws.

Essential Functions
These functions emphasize patient advocacy, analytical billing expertise, regulatory awareness, and high-quality service delivery.
Patient Payment & Account Support
  • Accurately process patient payments via phone in accordance with Privia financial responsibility policies.
  • Create, update, and maintain payment plans following established guidelines.
  • Ensure transaction accuracy, proper documentation, and data integrity.

Billing, Insurance & Claims Support
  • Interpret and clearly explain claim notes, balances, and billing outcomes to patients.
  • Verify, audit, and update insurance information for completeness and accuracy.
  • Add or update insurance data within the EMR and resubmit pending or corrected claims.
  • Educate patients on billing concepts including coordination of benefits, deductibles, coinsurance, copays, timely filing, and claim denials.
  • Identify discrepancies and coordinate with internal teams to resolve billing-related issues.

Problem Resolution & Patient Education
  • Research account history to determine the root cause of billing or payment concerns.
  • Recommend appropriate resolutions and next steps in alignment with Privia policies.
  • Maintain professionalism and empathy during complex or sensitive financial discussions.

Resource & System Utilization
  • Utilize Privia-approved billing systems, EMR platforms, tools, and knowledge resources.
  • Navigate multiple systems simultaneously while assisting patients.
  • Adhere to all documentation, privacy, and security requirements.

Reliability & Continuous Learning
  • Maintain schedule adherence and consistent availability during assigned hours.
  • Complete all required Privia and client-mandated training.
  • Participate in ongoing uptraining and cross-training initiatives.

Ethical & Compliant Conduct
  • Uphold HIPAA requirements, confidentiality standards, and Privia security protocols.
  • Demonstrate professionalism, accountability, and patient-centered service in all interactions.

Requirements
  • Strong verbal and written communication skills.
  • Analytical problem-solving abilities and high attention to detail.
  • Solid understanding of healthcare billing and insurance concepts.
  • Ability to clearly explain complex billing information in patient-friendly language.
  • Comfort working across multiple systems and tools simultaneously.
  • Organized, self-motivated, and collaborative approach to work.

Pay and Benefits
Starting pay - $14/hr plus shift differential(extra $1/hr nights & wkds)
Working hours between - 8:00am-5:00pm (CST) ; Work Days - M-F
Paid Training - typically 2 weeks in length from 8:00am-5:00pm Mon-Fri (CST)
Status - Full Time 40 hours, Benefit eligible 1st of month after 60 days
$14 - $14 an hour
The above statements are intended to describe the general nature and level of work and are not intended to be an exhaustive list of all responsibilities, duties, and skills required of the job
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

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