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Remote Utilization Review Nurse Practitioner Jobs in Appleton, WI

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Remote Utilization Review Nurse Practitioner information

See Appleton, WI salary details

$69.3K

$131.1K

$205.4K

How much do remote utilization review nurse practitioner jobs pay per year?

As of Aug 16, 2026, the average yearly pay for remote utilization review nurse practitioner in Appleton, WI is $131,107.00, according to ZipRecruiter salary data. Most workers in this role earn between $108,300.00 and $148,800.00 per year, depending on experience, location, and employer.

What is a remote utilization review nurse practitioner?

A Remote Utilization Review Nurse Practitioner is a licensed advanced practice nurse who evaluates the necessity, efficiency, and appropriateness of healthcare services, treatments, and hospital admissions, typically from a remote or home-based setting. They review patient medical records to ensure care meets established guidelines and insurance requirements, helping to control costs and ensure quality care. Their role often involves collaborating with physicians, insurance companies, and healthcare facilities to determine coverage and recommend alternative treatments when necessary. Working remotely, they rely heavily on electronic health records and telecommunication tools to perform their duties.

How does a remote utilization review nurse practitioner typically collaborate with healthcare teams while working offsite?

Remote Utilization Review Nurse Practitioners frequently collaborate with interdisciplinary teams through virtual meetings, secure messaging platforms, and electronic health record (EHR) systems. They work closely with physicians, case managers, and insurance representatives to review patient care plans, ensure medical necessity, and support appropriate resource utilization. Despite working remotely, maintaining clear communication and timely documentation is essential for seamless coordination and decision-making. Many organizations provide robust digital tools and regular team check-ins to facilitate collaboration and support remote staff.

What are the key skills and qualifications needed to thrive as a remote utilization review nurse practitioner, and why are they important?

To thrive as a Remote Utilization Review Nurse Practitioner, you need an advanced nursing degree (NP), active state licensure, and strong knowledge of clinical guidelines and insurance criteria. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) are often required. Critical thinking, strong communication, and a detail-oriented approach set top performers apart in this remote role. These skills ensure accurate, compliant, and efficient review of patient care while supporting healthcare cost management and patient advocacy.

What is the difference between Remote Utilization Review Nurse Practitioner vs Telehealth Nurse Practitioner?

AspectRemote Utilization Review Nurse PractitionerTelehealth Nurse Practitioner
CertificationsNP license, possibly certification in utilization reviewNP license, general telehealth certifications
Work EnvironmentReviewing medical records, insurance data remotelyProviding patient care via telehealth platforms
Employer & IndustryInsurance companies, healthcare organizationsHospitals, clinics, telehealth companies

The main difference is that Remote Utilization Review Nurse Practitioners focus on reviewing medical necessity and insurance claims remotely, while Telehealth Nurse Practitioners provide direct patient care via telehealth platforms. Both roles require NP licensure, but their daily tasks and work environments differ significantly.

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

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

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

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

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

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

Remote Utilization Review Nurse Practitioner jobs near you

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Re-posted 10 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 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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