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Remote Utilization Review Jobs in Madison, WI (NOW HIRING)

WPS

Medical Review Nurse Analyst

Madison, WI · On-site +1

$68K - $70K/yr

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 ...

WPS Health Solutions

Medical Director

Madison, WI · On-site +1

Three (3) or more years of experience in the health insurance industry, a utilization review firm ... Please review Remote Worker FAQs for additional information. Benefits * Remote and hybrid work ...

WPS

Medical Director

Madison, WI · On-site +1

Three (3) or more years of experience in the health insurance industry, a utilization review firm ... Please review Remote Worker FAQs for additional information. Benefits * Remote and hybrid work ...

LEARN Behavioral

RCM Coordinator (Remote)

Madison, WI · Remote

$24/hr

... review, denial resolution, appeals, and follow-up to maximize reimbursement and reduce accounts ... Partner with Clinical Operations, Utilization Management, Credentialing, and other cross-functional ...

SHINE Technologies LLC

Licensing Manager

Janesville, WI · On-site +1

$135K - $189K/yr

Hybrid or remote work arrangement will be considered. While our headquarters is located in ... Interface with regulatory agencies in the planning of regulatory engagements, regulatory reviews ...

SHINE Technologies LLC

Licensing Engineer

Janesville, WI · On-site +1

$73K - $121K/yr

... support of the review of licensing actions by the U.S. Nuclear Regulatory Commission; the ... Hybrid or remote work arrangement will be considered. While our headquarters is located in ...

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All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in Madison, WI

Remote Utilization Review information

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How much do remote utilization review jobs pay per hour?

As of Jul 27, 2026, the average hourly pay for remote utilization review in Madison, WI is $42.60, 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 in the Remote Utilization Review position, and why are they important?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What does a typical day look like for someone in a Remote Utilization Review role?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What is a Remote Utilization Review job?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What are the most commonly searched types of Utilization Review jobs in Madison, WI? The most popular types of Utilization Review jobs in Madison, WI are:
What are popular job titles related to Remote Utilization Review jobs in Madison, WI? For Remote Utilization Review jobs in Madison, WI, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Madison, WI look for? The top searched job categories for Remote Utilization Review jobs in Madison, WI are:
What cities near Madison, WI are hiring for Remote Utilization Review jobs? Cities near Madison, WI with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Madison, WI as of July 2026, with employment types broken down into 71% Full Time, 10% Part Time, 1% Temporary, and 18% Contract. Highlights an 43% Physical, 3% Hybrid, and 54% Remote job distribution, with an average salary of $88,617 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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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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