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Rn Utilization Management Jobs in Wisconsin (NOW HIRING)

Network Health

RN Care Manager

Menasha, WI · Remote

The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...

Network Health, Inc

RN Care Manager

Menasha, WI · Remote

The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...

Network Health

RN Care Manager

Menasha, WI · On-site

Description The Registered Nurse Care Manager provides case management services that are member ... Previous experience in case management, utilization management, insurance, or managed care ...

Network Health WI

RN Care Manager

Menasha, WI · On-site +1

The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...

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Showing results 21-40

All JobsRn Utilization Management JobsRn Utilization Management Jobs in Wisconsin

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 Aug 15, 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.

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 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 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 insurance policies and healthcare regulations. 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 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.

What does a utilization management registered nurse do?

A utilization management registered nurse reviews patient cases to determine the necessity, appropriateness, and efficiency of healthcare services and treatments. They analyze medical records, collaborate with healthcare providers, and ensure compliance with insurance and regulatory guidelines, often using electronic health records and clinical judgment. Certification in case management or utilization review is commonly required for this role.

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 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, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $90,320 per year, or $43.4 per hour.

RN Field Case Manager

Healthcare Support Staffing

Milwaukee, WI

$76K - $97K/yr

Full-time

Re-posted 13 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description
  • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
  • Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
  • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
  • Provide patient and provider education
  • Facilitate member access to community based services
  • Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
  • Actively participate in integrated team care management rounds
  • Identify related risk management quality concerns and report these scenarios to the appropriate resources.
  • Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
  • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Qualifications
  • Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred.
  • 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience 
  • Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
  • Licenses/Certifications: Current state's RN license
Additional Information

Interested in being considered? 

If you are interested in applying to this position, please contact Edgar Pablo @ 407-478-0332 ext 114 and click the Green I'm Interested Button to email your resume.

Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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