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Utilization Case Manager Jobs in Wisconsin (NOW HIRING)

Child Welfare Case Manager

Oconto, WI · On-site

$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 ...

Case Manager I - TCM

Milwaukee, WI · On-site

$19.75 - $25.25/hr

The Case Manager will develop and implement the treatment plan, which will include the necessary ... Coordinate utilization of various community resources, day programs and outside health care ...

Case Manager I - TCM

Milwaukee, WI · On-site

$19.75 - $25.25/hr

The Case Manager will develop and implement the treatment plan, which will include the necessary ... Coordinate utilization of various community resources, day programs and outside health care ...

$52K - $78K/yr

Previous case management, care coordination, population health, utilization management, or chronic disease management experience preferred. * Strong clinical assessment, critical thinking, and care ...

The Case Manager works with physicians and multidisciplinary team members to develop a plan of care ... Conducts utilization reviews. * Communicates appropriate information for timely updates and ...

Showing results 21-40

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:
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 - Drug Treatment Court (DTC)

Wisconsin Community Services

Milwaukee, WI

$19 - $24.25/hr

Full-time

Posted 25 days ago


Job description

Wisconsin Community Services
Case Manager - Waukesha Drug Treatment Court (DTC)
Job Summary

The case manager is responsible for the day-to-day operations of the Waukesha County Drug Treatment Court, a post-plea and pre-disposition specialty court, which provides intensive support and monitoring of eligible drug offenders. Other responsibilities include providing routine updates and working collaboratively with the Drug Treatment Court Staffing Team, which includes the Drug Court Judge, as well as a representative from the District Attorney’s Office, Public Defender’s Office, Department of Corrections (DOC) and Waukesha County Health and Human Services (WCHHS).

Essential Duties and Responsibilities

  • Responsible for a range of case management services, providing structure, accountability, evidence-based programming and support for successful compliance while in the community.
  • Engage in supervision case management activities, including but not limited to: reviewing applications and discussing with the Supervisor and Drug Court Team, completing all required assessments prior to admission and intake and following through on the results; conducting new intakes and explaining the program components to participants, conducting face-to-face supervision appointments with participants to monitor compliance/non-compliance with all phase requirements and terms of supervision, refer to supportive services based on need, routine alcohol and drug testing, working with local treatment providers to ensure participants’ enrollment in and compliance with treatment, and monitor all participants’ compliance with all related fees (program, court, treatment), etc.
  • Creation of and maintenance of a hard file for each person in the program according to program protocols.
  • Create and follow case plans for each person in the DTC program, tracking progress made and phases/goals achieved.
  • Make referrals and monitor community-based services including treatment, employment, education and other supportive services.
  • Coordinate treatment provider referrals and monitor provider standards and accountability.
  • Ensure that the Treatment Court supervision model and its core elements are followed, including use of the LS/CMI risk and need assessment tool.
  • Enter appropriate data into the WCS AWARDS and CORE databases, ensuring timely and complete data entry.
  • Develop the weekly court calendar and attend and contribute to pre-hearing staffings and court hearings.
  • Collaborate closely with the Treatment Court Team.
  • Assist in representing the Drug Treatment Court at local, state and national meetings and training courses.
  • Assist with drug testing in the Waukesha Court Services programs, ensuring the integrity of all alcohol and drug testing procedures. Employees will also conduct drug and alcohol screens as needed, including weekend testing every 4-6 weeks as scheduled on Saturdays, from 7am to 10am.
  • Network with and maintain positive relationships with community resource providers.
  • Make recommendations and assist Court in determining Phase levels, sanctions, and incentives.
  • Assist with maintaining quality assurance of all written and electronic files and court communication.
  • Ensure protection of client confidentiality and compliance with all HIPAA policies.
  • Develop creative incentives and reward celebrations for persons served; may include soliciting potential donations for incentive gifts.
  • Coordinate utilization of the SCRAM system; work with WCS SCRAM staff, including the Program Director of Post Conviction Services to address issues – especially outstanding balances with fees owed by people in the program.
  • Responsible for assisting the Lead Case Manager and Program Director of Post Conviction Services with reporting and evaluation to fulfill the requirements of the funding source.
  • Assist the Program Director of Post Conviction Services to add people to the drug testing calling line and communicate with other WCS staff involved.
  • Notify the lead case manager, or in her absence, the program director, of any issues of non-compliance with people served immediately.
  • Attend the Waukesha County Victim Impact Panel at least once per year.
  • Attend all required training, including discipline-specific training on case management.
  • Maintain a flexible work schedule when needed to provide coverage in the office when necessary.
  • Other job-related duties may be necessary to carry out the responsibilities of the position.

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