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Remote Utilization Review Rn Jobs in Madison, WI

WPS

Medical Review Nurse Analyst

Madison, WI · On-site +1

$68K - $70K/yr

Active RN license, applicable to state of practice in good standing. * 1 or more years of clinical ... Experience with medical record review or utilization review. Remote Work Requirements * Wired ...

WPS Health Solutions

Medical Director

Madison, WI · On-site +1

Work with RN(s) on local coverage determinations - reviewing new procedures that may involve new ... Remote Work Requirements * Wired (ethernet cable) internet connection from your router to your ...

WPS

Medical Director

Madison, WI · On-site +1

Work with RN(s) on local coverage determinations - reviewing new procedures that may involve new ... Remote Work Requirements * Wired (ethernet cable) internet connection from your router to your ...

Quartz

RN Complex Care Specialist

Madison, WI · Remote

$72K - $90K/yr

As an RN Complex Care Specialist , you will lead the management and coordination of care for ... Proficiency using Epic systems and remote monitoring programs. * Cultural competence and ...

MDS Solutions

REMOTE MDS Coordinator

Madison, WI · Remote

$34.50 - $44/hr

Review and verify MDS documentation and charting requirements to support the clinical services ... Nursing Experience in MDS Assessment: 3+ year * RN required * RAC-CT preferred * Thorough ...

UW Health

Home Based Hospital Care-In Home RN

Madison, WI · On-site +1

$40.30 - $60.45/hr

... remote patient monitoring, video visits, and mobile diagnostic services to support safe, high ... Licensed as a Registered Nurse (RN) in the State of WI or holds a license issued by a jurisdiction ...

Urrly

Telehealth Nurse Practitioner (Remote)

Madison, WI · Remote

$600 - $720/hr

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

Corvel

Care Advocate Nurse

Madison, WI · Remote

$61K - $98K/yr

... ies), reviews medical data in CareMC, validates and secures medical information, assesses and ... This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Initiates and receives telephonic ...

Corvel

Care Advocate Nurse

Madison, WI · Remote

$61K - $98K/yr

... ies), reviews medical data in CareMC, validates and secures medical information, assesses and ... This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Initiates and receives telephonic ...

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Remote Utilization Review Rn information

See Madison, WI salary details

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$42

$69

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

As of Jul 27, 2026, the average hourly pay for remote utilization review rn in Madison, WI is $42.61, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $48.94 per hour, depending on experience, location, and employer.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
What are popular job titles related to Remote Utilization Review Rn jobs in Madison, WI? For Remote Utilization Review Rn jobs in Madison, WI, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Madison, WI look for? The top searched job categories for Remote Utilization Review Rn jobs in Madison, WI are:
What cities near Madison, WI are hiring for Remote Utilization Review Rn jobs? Cities near Madison, WI with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Madison, WI as of July 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 $88,631 per year, or $42.6 per hour.
Medical Review Nurse Analyst

Medical Review Nurse Analyst

WPS

Madison, WI • On-site, Remote

$68K - $70K/yr

Full-time

Medical, Dental, Retirement, PTO

Posted 10 days ago

Job description

Our Medical Review Nurse Analyst is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This analyst ensures that providers are being reimbursed appropriately for services provided based on Medicare guidelines. This Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements.
Salary Range$68,000 - $70,000The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.We are open to remote work in the following approved states:Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
How do I know this opportunity is right for me? If you:
  • Can perform detailed reviews of medical records and documentation to determine the medical necessity of services.
  • Would enjoy reviewing submitted claims to ensure that billed services are medically necessary and correctly coded based on Medicare guidelines.
  • Want to ensure Medicare providers are correctly reimbursed when documentation supports services rendered.
  • Have prepared written clinical summaries and determinations with clear rationale for approvals, denials, or modifications.
  • Would like to educate providers in accordance with the Targeted Probe and Educate (TPE) program.
  • Can monitor the progress of assigned providers and educate on current billing and documentation requirements.
  • Want to ensure compliance with federal and state regulations, CMS guidelines, and company policies.
  • Enjoy staying current on clinical guidelines, medical policy updates, and industry best practices.

Minimum Qualifications
  • Associate's (ASN) or Bachelor's Degree in Nursing (BSN).
  • Active RN license, applicable to state of practice in good standing.
  • 1 or more years of clinical experience in a healthcare setting (hospital, homecare, skilled nursing, etc.).
  • Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
  • Strong attention to detail and organizational skills to manage multiple cases simultaneously.
  • Basic knowledge and understanding of medical/clinical review processes.
  • Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel.

Preferred Qualifications
  • Experience working for a Medicare Administrative Contractor (MAC).
  • Familiarity with Medicare guidelines and reimbursement processes.
  • Experience with medical record review or utilization review.

Remote Work Requirements
  • Wired (ethernet cable) internet connection from your router to your computer
  • High speed cable or fiber internet
  • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
  • Please review Remote Worker FAQs for additional information

Benefits
  • Remote work options available
  • Performance bonus and/or merit increase opportunities
  • 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
  • Competitive paid time off
  • Health insurance, dental insurance, and telehealth services start DAY 1
  • Professional and Leadership Development Programs
  • Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.
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This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services
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