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Rn Utilization Management Jobs in Wisconsin (NOW HIRING)

St. Luke's University Health Network

WI · On-site

$60 - $80/hr

Works as a team with other members of care management, including RN care managers, assistants, coordinators, utilization management staff, and director. * Facilitates communication among all ...

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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.

RN Care Manager - Condition/Disease Management Focus

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Re-posted 4 days ago

Network Health rating

7.9

Company rating: 7.9 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

188th of 315 rated insurance

Job description

The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual's and family's comprehensive health needs through communication and coordination of available resources to promote quality, cost-effective outcomes.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day.
Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday
Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:
  • Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines. Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies
  • Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved
  • Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff
  • Evaluate and process member referrals from physicians to other specialty providers
  • Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met
  • Works with members and families on self-management approaches using coaching techniques such as motivational interviewing
  • Educate the individual, his/her family and caretakers about case and condition management, the individual's health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes.
  • Facilitate the coordination, communication and collaboration of the individual's care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality.
  • Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning.
  • Stay abreast of current best practices and new developments
  • Other duties as assigned

Job Requirements:
  • Graduation from accredited school of nursing
  • Bachelor's degree in Nursing preferred
  • RN licensure in the State of Wisconsin
  • Case Management certification preferred
  • Four years of clinical health care experience as a RN required
  • Chronic condition management experience preferred, especially:
    • Diabetes
    • Cardiac
    • Pulmonology
  • Previous experience in case management, utilization management, insurance, or managed care preferred
  • Experience with Medicare, Medicaid preferred

Network Health is an Equal Opportunity Employer
Equal Opportunity Employer
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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