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Rn Utilization Management Jobs in Wisconsin (NOW HIRING)

Socket.dev

WI · On-site

$100 - $125/hr

Assists in implementing care management, utilization management, behavioral health, care ... At least 1 year of management/leadership experience. * Registered Nurse (RN), Licensed Vocational ...

SSM Health

Registered Nurse - Case Manager

Madison, WI · On-site

May also be responsible for: utilization management process, ED case management process, admission ... Registered Nurse (RN) - Missouri Division of Professional Registration State of Work Location:

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Rn Utilization Management information

See Wisconsin salary details

$39.4K

$90.3K

$164.5K

How much do rn utilization management jobs pay per year?

As of Sep 7, 2026, the average yearly pay for rn utilization management in Wisconsin is $90,320.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,100.00 and $105,500.00 per year, depending on experience, location, and employer.

What is an RN Utilization Management?

RN Utilization Management nurses are registered nurses who specialize in reviewing healthcare services to ensure patients receive appropriate and cost-effective care. They evaluate the necessity, efficiency, and quality of medical treatments and procedures, often working with insurance companies, hospitals, or healthcare organizations. Their responsibilities include reviewing patient records, coordinating with clinical staff, making coverage recommendations, and ensuring compliance with healthcare regulations. This role helps manage healthcare costs while maintaining high standards of patient care.

What skills and qualifications are needed to thrive as an RN Utilization Management?

To thrive as an RN Utilization Management Nurse, you need a current RN license, strong clinical assessment skills, and experience in care coordination or case management. Familiarity with utilization review tools, electronic health records, and knowledge of insurance guidelines or InterQual/MCG criteria are typically required. Exceptional communication, critical thinking, and negotiation skills help facilitate collaboration among providers, payers, and patients. These abilities are crucial for ensuring appropriate resource use, compliance with regulations, and optimal patient outcomes.

How does an RN Utilization Management typically collaborate with physicians and other healthcare team members?

RN Utilization Management professionals work closely with physicians, case managers, and insurance representatives to ensure patients receive appropriate, high-quality care while managing healthcare costs. They review patient records, communicate clinical findings, and may participate in interdisciplinary meetings to discuss care plans and discharge needs. Building strong relationships and maintaining open lines of communication with the care team is essential for timely authorizations and effective care coordination. This collaborative approach helps optimize patient outcomes and resource utilization.

What is the difference between Rn Utilization Management vs Rn Case Management?

AspectRn Utilization ManagementRn Case Management
CertificationsRN license, possibly certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentUtilization review departments, insurance companies, hospitalsCommunity clinics, hospitals, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Both roles require an RN license, but Rn Utilization Management focuses on reviewing the necessity of services, while Rn Case Management emphasizes coordinating patient care. Understanding these differences helps professionals choose the right career path and employers.

How to get into utilization management as an RN?

To become an RN in utilization management, gain experience as a registered nurse, often in case management or clinical roles, and obtain knowledge of healthcare policies and insurance processes. Certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) can enhance prospects. Strong communication skills and familiarity with electronic health records (EHR) systems are also beneficial.

What are popular job titles related to Rn Utilization Management jobs in Wisconsin?

For Rn Utilization Management jobs in Wisconsin, the most frequently searched job titles are:

What job categories do people searching Rn Utilization Management jobs in Wisconsin look for?

The top searched job categories for Rn Utilization Management jobs in Wisconsin are:

Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 82% Physical, 2% Hybrid, and 16% Remote job distribution, with an average salary of $90,320 per year, or $43.4 per hour.

Manager, Healthcare Services - MUST RESIDE IN TEXAS

Socket.dev

WI • On-site

$100 - $125/hr

Other

Medical

Posted 5 days ago

Job description

Job Summary

Leads and manages a multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties
  • Oversees team performance for one or more of the following healthcare services functions: care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, behavioral health, long-term services and supports (LTSS), and/or special programs.
  • Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model.
  • Functions as a "hands-on" leader - assisting with assessing and evaluation of systems, day-to-day operations and efficiency of services/care delivery.
  • Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators.
  • Assists in implementing care management, utilization management, behavioral health, care transitions, LTSS and other program activities in accordance with regulatory, contract standards and accreditation compliance.
  • Ensures delivery of member care and services are aligned with Molina's established standards of customer service excellence.
  • Ensures high-risk, complex members are adequately supported.
  • Oversees ongoing monitoring of performance, protocols and guidelines related to healthcare services.
  • Collaborates with and keeps senior level healthcare services leadership apprised of operational issues, staffing, resources, system and program needs.
  • Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care.
  • Oversees interdisciplinary care team (ICT) meetings.
  • Analyzes and reports on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities.
  • Ensures completion of staff quality audit reviews evaluates services provided, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines.
  • Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate.
  • Identifies opportunities for care delivery/quality/operational/etc. process improvements.
  • Hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals.
  • Local travel may be required (based upon state/contractual requirements).
Required Qualifications
  • At least 7 years of health care experience, including at least 3 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or special programs, or equivalent combination of relevant education and experience, or equivalent combination of relevant education and experience.
  • At least 1 year of management/leadership experience.
  • Registered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
  • Strong customer service skills/member-centric focus.
  • Ability to work within a variety of settings and adjust style as needed, including ability to work with diverse populations, various personalities and personal situations.
  • Ability to prioritize and manage multiple deadlines.
  • Strong organizational and problem-solving skills.
  • Ability to collaborate cross-functionally within a highly matrixed organization.
  • Strong written and verbal communication skills.
  • Microsoft Office suite and applicable software program(s) proficiency.
Preferred Qualifications
  • Clinical experience.
  • Registered Nurse (RN) or master's level behavioral health (BH) licensure. License must be active and unrestricted in state of practice.
  • Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification.
  • Medicaid/Medicare population experience.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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