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Remote Utilization Review Nurse Jobs in Wisconsin

Urrly

Telehealth Nurse Practitioner

Madison, WI · On-site +1

$600 - $720/day

Location/Type: Wisconsin Remote (No travel) * Pay: $600-$720/day (1099 contractor, based on ... Review medical history, medications, and preventive needs * Document visits using ICD-10 and CPT II ...

ChenMed

... systems through the utilization of data demonstrating program effectiveness and success ... record review by the respective delegating physician. * If supporting patients in Tennessee ...

New

MDS Solutions

REMOTE MDS Coordinator

Milwaukee, WI · Remote

$33.75 - $43/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Green Bay, WI · On-site +1

$33.25 - $42.50/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Madison, WI · On-site +1

$34.50 - $44/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Madison, WI · On-site +1

$34.50 - $44/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Madison, WI · Remote

$34.50 - $44/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Green Bay, WI · On-site +1

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Milwaukee, WI · On-site +1

$33.75 - $43/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Green Bay, WI · Remote

$33.25 - $42.50/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

MDS Solutions

REMOTE MDS Coordinator

Milwaukee, WI · On-site +1

$33.75 - $43/hr

This role requires a RN license, LPN will not meet the minimum qualifications. What do we offer you ... Review and verify MDS documentation and charting requirements to support the clinical services ...

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Remote Utilization Review Nurse information

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$21

$42

$69

How much do remote utilization review nurse jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for remote utilization review nurse 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.

What is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

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

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

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

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

More about Remote Utilization Review Nurse jobs

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

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Cities in Wisconsin with the most Remote Utilization Review Nurse job openings:

Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Wisconsin as of August 2026, with employment types broken down into 88% Full Time, 6% Part Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $88,769 per year, or $42.7 per hour.

Utilization Management Nurse RN - Per Diem - Remote

UnitedHealth Group

Waukesha, WI • On-site, Remote

Full-time

Retirement

Posted 3 days ago

New

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

190th of 893 rated healthcare providers

Job description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Utilization Management Nurse RN is responsible for performing utilization management activities to support appropriate use of healthcare services, compliance with established medical necessity criteria, and timely coordination across the care team and payer partners. The role supports admission reviews, concurrent reviews, continued stay reviews, authorization management, denial prevention, and appeals support when appropriate.
This role is expected to operate with minimal guidance on most responsibilities, manage moderately complex work, assess needs, translate concepts into practice, and serve as a resource for others with less experience.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Perform utilization review and medical necessity assessments for inpatient admissions and continued stays
  • Conduct concurrent reviews using established clinical criteria and organizational guidelines
  • Collaborate with physicians, case managers, social workers, and interdisciplinary partners to support patient care coordination and appropriate resource utilization
  • Communicate with Medicare, Medicaid, commercial payers, and third-party reviewers regarding authorization and continued stay requirements
  • Support denial prevention activities and assist with appeals processes when appropriate
  • Apply InterQual, MCG/Milliman, or other evidence-based criteria to evaluate medical necessity
  • Maintain compliance with CMS standards and applicable regulatory requirements
  • Document utilization review activities and payer communications accurately and timely
  • Independently manage assigned workload, prioritize competing demands, and escalate complex issues when needed
  • Provide explanations, guidance, and support to team members on utilization management processes and moderately complex issues

Skills and Capabilities:
  • Demonstrated analytical, critical thinking, and problem-solving skills
  • Effective verbal and written communication skills
  • Ability to work independently with minimal guidance on routine and moderately complex responsibilities
  • Ability to assess customer needs, identify solutions to non-standard requests, and translate concepts into practice
  • Demonstrated organizational skills and ability to manage multiple priorities in a telecommuter environment

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Current, active, unrestricted Registered Nurse (RN) license in the state of Wisconsin (or Compact to include the state of Wisconsin)
  • 3+ years of professional nursing experience
  • Experience in utilization management, utilization review, case management, care coordination, medical necessity review, or a closely related clinical review function
  • Experience evaluating clinical documentation and applying judgment to support appropriate care coordination or resource utilization
  • Experience communicating with internal clinical stakeholders, payers, or external partners regarding care coordination, authorization, clinical documentation, or review outcomes
  • Ability to work any of our per diem (as needed) shift schedules during our normal business hours (8am - 4:30pm), including flexibility to work both weekday and weekend shifts

Preferred Qualifications:
  • Bachelor of Science in Nursing (BSN)
  • Utilization Management or Utilization Review experience
  • Experience supporting acute inpatient populations, concurrent review, or continued stay review
  • Experience using InterQual, MCG/Milliman, or other evidence-based medical necessity criteria
  • Experience with Medicare, Medicaid, commercial payer, managed care, authorization, or payer follow-up processes
  • Experience working successfully in a remote or telecommuter role
  • Denials management, denial prevention, or appeals support experience
  • Proven ability to serve as a clinical resource to others and provide guidance on moderately complex issues

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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