... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
Registered Nurse Care Manager - Sheboygan, Plymouth, Oostburg, Kohler - Sheboygan, WI
Sheboygan, WI · On-site
Back Registered Nurse Care Manager - Sheboygan, Plymouth, Oostburg, Kohler #26-175 Sheboygan ... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ...
Registered Nurse Care Manager - Sheboygan, Plymouth, Oostburg, Kohler - Sheboygan, WI
Sheboygan, WI · On-site
Back Registered Nurse Care Manager - Sheboygan, Plymouth, Oostburg, Kohler #26-175 Sheboygan ... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ...
RN Field Case Manager
Milwaukee, WI · On-site
$76K - $97K/yr
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.
RN Field Case Manager
Milwaukee, WI · On-site
$76K - $97K/yr
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.
RN Field Case Manager
Milwaukee, WI · On-site
$68K/yr
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.
RN Field Case Manager
Milwaukee, WI · On-site
$68K/yr
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.
The Inpatient Utilization Review RN is a key member of the healthcare team responsible for ensuring ... of care. Payer Authorization and Denial Management * Obtain and maintain required payer ...
New
The Inpatient Utilization Review RN is a key member of the healthcare team responsible for ensuring ... of care. Payer Authorization and Denial Management * Obtain and maintain required payer ...
New
Monitor and oversee the readiness, safety, utilization, and lifecycle management of imaging and ... Analyze imaging and Heart Care reports and data to identify areas for improvement and implement ...
New
Quick apply
Monitor and oversee the readiness, safety, utilization, and lifecycle management of imaging and ... Analyze imaging and Heart Care reports and data to identify areas for improvement and implement ...
New
The Inpatient Utilization Review RN is a key member of the healthcare team responsible for ensuring ... of care. Payer Authorization and Denial Management * Obtain and maintain required payer ...
New
Quick apply
The Inpatient Utilization Review RN is a key member of the healthcare team responsible for ensuring ... of care. Payer Authorization and Denial Management * Obtain and maintain required payer ...
New
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
... utilization, and high-quality, patient-centered care. This role implements evidence-based clinical ... Coordinates comprehensive care management activities across the continuum, including pre-visit ...
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
Clinical Management Manager
$94K - $293K/yr
Design and implement care delivery models, workflows, and utilization management solutions * Drive measurable improvements in patient flow, capacity, LOS, and avoidable utilization * Partner with ...
New
Clinical Management Manager
$94K - $293K/yr
Design and implement care delivery models, workflows, and utilization management solutions * Drive measurable improvements in patient flow, capacity, LOS, and avoidable utilization * Partner with ...
New
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
New
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
New
Manage participant referrals, scheduling, and service utilization. * Maintain compliance with licensing regulations, HCBS standards, and agency policies. * Monitor documentation, care plans, and ...
Manage participant referrals, scheduling, and service utilization. * Maintain compliance with licensing regulations, HCBS standards, and agency policies. * Monitor documentation, care plans, and ...
Registered Nurse (RN) - Care Manager
Kenosha, WI · On-site
$11/hr
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
Registered Nurse (RN) - Care Manager
Kenosha, WI · On-site
$11/hr
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
Registered Nurse (RN) - Care Manager
Pleasant Prairie, WI · On-site
$11/hr
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
Registered Nurse (RN) - Care Manager
Pleasant Prairie, WI · On-site
$11/hr
Partner with patients, families, and the care team to assess needs, coordinate services, plan discharges, and support utilization management. We're Looking For: License/Registration/Certification:
The RPM RN will provide individualized patient assessment, patient education, medication management ... Early detection and intervention for adverse health trends may decrease acute care utilization ...
The RPM RN will provide individualized patient assessment, patient education, medication management ... Early detection and intervention for adverse health trends may decrease acute care utilization ...
We deliver personalized health care experiences and partner closely with providers to ensure ... The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ...
We deliver personalized health care experiences and partner closely with providers to ensure ... The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ...
Utilization Care Manager information
What is a utilization care manager?
Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.
How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?
Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.
What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?
To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.
What is the difference between Utilization Care Manager vs Utilization Review Nurse?
| Aspect | Utilization Care Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, case management certification | RN, certification in utilization review |
| Work Environment | Healthcare facilities, insurance companies | Hospitals, insurance companies, outpatient clinics |
| Primary Focus | Coordinating patient care, managing resources | Reviewing medical necessity, approving treatments |
Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.
What does a utilization care manager do in healthcare?
A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.
What are popular job titles related to Utilization Care Manager jobs in Wisconsin?
For Utilization Care Manager jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Utilization Care Manager jobs in Wisconsin look for?
The top searched job categories for Utilization Care Manager jobs in Wisconsin are:
What cities in Wisconsin are hiring for Utilization Care Manager jobs?
Cities in Wisconsin with the most Utilization Care Manager job openings:
Full-time
Re-posted 11 days ago
Prevea Health rating
7.6
Based on 41 frontline employees who took The Breakroom Quiz
190th of 889 rated healthcare providers
Job description
This position will work 32 hours per week
RN (Care Manager)
Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.
Job Summary
The Registered Nurse (RN) Care Manager coordinates and manages the continuum of care for an assigned patient population to promote optimal health outcomes, effective resource utilization, and high-quality, patient-centered care. This role implements evidence-based clinical guidelines, supports care transitions, and collaborates with providers, patients, and families to reduce avoidable utilization and improve clinical, financial, and quality outcomes.
What you will do
Education Qualifications
Experience Qualifications
Skills and Abilities
Licenses and Certifications
Physical Demands
Working Conditions
Travel Requirements
Hearing Requirements
Vision Requirements
Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify
RN (Care Manager)
Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.
Job Summary
The Registered Nurse (RN) Care Manager coordinates and manages the continuum of care for an assigned patient population to promote optimal health outcomes, effective resource utilization, and high-quality, patient-centered care. This role implements evidence-based clinical guidelines, supports care transitions, and collaborates with providers, patients, and families to reduce avoidable utilization and improve clinical, financial, and quality outcomes.
What you will do
- Coordinates comprehensive care management activities across the continuum, including pre-visit planning, care transitions, follow-up after hospital or emergency department encounters, and collaboration with internal and external care teams.
- Educates patients and families on disease management, treatment plans, preventive care, and clinical measurements, reinforcing self-management skills and informed decision-making.
- Facilitates efficient care delivery by coordinating multiple clinician visits, diagnostic testing, and services, when possible, while identifying and connecting patients to appropriate insurance, financial, and community resources.
- Develops, implements, and evaluates individualized care plans in partnership with patients, families, and providers, establishing treatment goals and addressing barriers to successful outcomes related to medications, appointments, social determinants, and adherence.
- Implements standing orders and evidence-based protocols for medication refills, diagnostic testing, preventive services, and disease-specific management, ensuring timely and appropriate care delivery.
- Manages transitions of care by reviewing external clinical information, contacting patients post-discharge, coordinating follow-up services, and developing written transition plans when patients move between care settings or providers.
- On an as needed basis, prepares and reviews patient charts prior to appointments, conducts clinical triage to determine urgency of care needs, and provides telephonic nursing guidance within established protocols and scope of practice.
Education Qualifications
- Graduation from an accredited and approved Nursing program Required
- Bachelor's Degree in Nursing Preferred
Experience Qualifications
- 3-5 years in a healthcare clinic setting Preferred
Skills and Abilities
- Skilled in establishing and maintaining effective working relationships with patients, medical staff, and the public
- Excellent interpersonal skills and behaviors
- Knowledge of common safety hazards and precautions to establish a safe work environment
- Competent in patient education/teaching
- Ability to assist providers with exams, tests & treatments
- Strong patient assessment skills in person and on the phone in a high-volume, fast-paced environment
- Ability to administer immunizations and medications
- Specialty skills as needed per department. Examples include IV starts, care/case management and pacemaker management.
Licenses and Certifications
- Current Wisconsin RN license or compact equivalent (nurses must maintain or update their primary state of residence to Wisconsin to ensure continued eligibility under the compact) Upon Hire Required
- CPR certification- Basic Life Support for Healthcare Providers certification from an approved program. Upon Hire Required
Physical Demands
- Sit - Constantly
- Stand - Rarely
- Walk - Rarely
- Drive - Rarely
- Climb (Stairs/Ladders) - Rarely
- Bend (Neck) - Occasionally
- Bend (Waist) - Rarely
- Squat - Rarely
- Twist/Turn (Neck) - Frequently
- Twist/Turn(Waist) - Occasionally
- Lift/Carry 0-10 lbs. - Rarely
- Lift/Carry 11-25 lbs. - Rarely
- Lift/Carry 26-35 lbs. - Rarely
- Lift/Carry 36-50 lbs. - Rarely
- Push/Pull up to 10 lbs. - Occasionally
- Push/Pull 11-25 lbs. - Occasionally
- Push/Pull 26-35 lbs. - Occasionally
- Push/Pull 36-50 lbs. - Occasionally
- Push/Pull 51-75 lbs. - Occasionally
- Push/Pull 76-100 lbs. - Rarely
- Reach (Above shoulder level) - Occasionally
- Reach (Below shoulder level) - Occasionally
- Simple Grasping (Hands/Arms) - Constantly
- Fine Manipulation (Hands/Arms) - Constantly
- Gross Manipulation (Hands/Arms) - Frequently
Working Conditions
- Noise - Occasionally
Travel Requirements
- 5%
Hearing Requirements
- Hears Whispers < 3 feet - Constantly
- Hears Whispers 3-8 feet - Constantly
Vision Requirements
- Color Discrimination - Constantly
- Near Vision (Correctable to Jaeger 2 or 20/40 binocular) - Constantly
- Distance Vision (Correctable to Snellen chart 20/40 binocular) - Constantly
Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify
What Prevea Health employees say
Pay
Benefits
Hours and flexibility
Workplace
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About PREVEA HEALTH
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Green Bay, WI, US
Year founded
1996