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Utilization Case Manager Jobs in Wisconsin (NOW HIRING)

Ascension

Case Management Manager

Milwaukee, WI · On-site

$19.75 - $25.25/hr

Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. * Develop staff schedule and revise assignments daily ...

Ascension

Case Management Manager

Milwaukee, WI · On-site

$99K/yr

Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. * Develop staff schedule and revise assignments daily ...

FROEDTERT HEALTH

RN CASE MANAGER

Menomonee Falls, WI · On-site

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

Froedtert Health

RN CASE MANAGER

Milwaukee, WI · On-site

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

Froedtert

RN CASE MANAGER

Milwaukee, WI · On-site

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

Froedtert Health

RN CASE MANAGER

Menomonee Falls, WI · On-site

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

FROEDTERT HEALTH

RN CASE MANAGER

Milwaukee, WI · On-site

... utilization and monitoring of healthcare resources. The RN Case Manager utilizes standards, guidelines, and protocols for care delivery and incorporates data to continuously improve care and outcomes.

Oconto County (WI)

Child Welfare Case Manager

Oconto, WI

$29.07 - $32.09/hr

The case manager must understand, support and work within the values, mission, and vision of the ... Proficient computer utilization skills. Supplemental Information When applying please attach a ...

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Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

What is the difference between Utilization Case Manager vs Utilization Review Nurse?

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Wisconsin? For Utilization Case Manager jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Wisconsin look for? The top searched job categories for Utilization Case Manager jobs in Wisconsin are:
What cities in Wisconsin are hiring for Utilization Case Manager jobs? Cities in Wisconsin with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Wisconsin as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 86% In-person, and 14% Remote job distribution.

Case Manager - Inpatient Rehab

Select Medical

Madison, WI • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 27 days ago

Job description

Select Medical Madison Rehabilitation Hospital

*A joint venture with Select Medical & Hospital*

Madison, Wisconsin

 

Case Manager (RN, SW, RT, LPN) 

M-F 8HR Shifts *As Needed Basis*

Why Join Us?

  • Start Strong: Extensive and thorough orientation program to ensure a smooth transition into our setting
  • Recharge & Refresh: Generous PTO and Paid Sick Time for full-time team members to maintain a healthy work-life balance
  • Your Health Matters: Comprehensive medical/RX, health, vision, employee assistance program (EAP) and dental plan offerings for full-time team members
  • Invest in Your Future: Company-matching 401(k) retirement plan, as well as life and disability protection for full-time team members
  • Your Impact Matters: Join a team of over 44,000 committed to providing exceptional patient care

Position Summary

The Case Manager is responsible for the coordination of health care decisions by using a systematic approach to assure treatment plans that improve quality and outcomes, coordination of care across the continuum; promotion of cost-effective care within the allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the discharge planning process.

The primary job functions in Case Management include:

  • Clinical Interventions/Discharge Planning
  • Care Planning Management
  • Fiscal Management
  • Payer/Referral Management

Minimum Qualifications

  • Current Licensure per sate guidelines in a clinical or related discipline OR a Bachelor's or Master's in health or human services discipline. 

Previous Experience 

  • Previous experience in Case Management and Discharge Planning preferred.
  • CCM Certification Preferred.

Equal Opportunity Employer/including Disabled/Veterans

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