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Utilization Case Manager Jobs in Wisconsin (NOW HIRING)

ClearSky Health

Case Manager - PRN

Cleveland, WI

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 ...

Corvel

RN Field Case Manager I

Waukesha, WI · On-site

$62K - $93K/yr

As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Corvel

RN Field Case Manager I

Waukesha, WI · On-site

$62K - $93K/yr

As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Corvel

RN Field Case Manager I

Waukesha, WI · On-site

$62K - $93K/yr

As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Wisconsin

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 - PRN

ClearSky Health

Cleveland, WI

Part-time

Re-posted 11 days ago

Job description

Our hospital provides high-quality care that transforms the lives of those living with disabling injuries and illnesses. We distinguish ourselves through our commitment to excellence, to our patients, to our employees, and to the communities we serve.

The Case Manager works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures patient is progressing towards desired outcomes by monitoring care through assessments and/or patient records. Identifies and resolves barriers that hinder effective patient care. Actively involved in discharge planning process. This position must integrate company values into daily practice.

This Position will serve as PRN

Essential Functions:

  • Communicates, collaborates, and coordinates with team members to provide quality patient care and to ensure positive patient outcomes. Facilitates communication during interdisciplinary team conference.
  • Responsible for accreditation standards and adheres to all standards set forth by the State and accrediting agencies of TJC and CMS.
  • Documents communication and coordination or patient activities, medical necessity, and post discharge equipment and support needs in the health care record.
  • Supports and facilitates length of stay management. Conducts utilization reviews.
  • Communicates appropriate information for timely updates and authorizations with payors. Ensures the outcome of this information is timely communicated to clinical team and administration.
  • May be required to work during inclement weather and other staffing emergencies.
  • Provides an environment conducive to safety for patients, visitors, and staff. Assesses the risks for safety and implements appropriate precautions. Complies with appropriate and approved safety and Infection Prevention standards.
  • Performs other duties as assigned to support overall effectiveness of the organization.

Minimum Job Requirements


Minimum Education & Experience:

  • Two years' recent relevant experience required.
  • Acute care setting preferred.
  • Bachelor's degree preferred.

Required Licenses, Certifications, and/or Documentation:

  • Current state clinical licensure required.
  • Must maintain acceptable driving record, current driver's license, and insurability.

Required Knowledge, Skills, and Abilities:

  • Demonstrates an understanding of treatment costs and financial support as they relate to quality and efficiency.
  • Demonstrates critical thinking skills: Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
  • Knowledge of community resources to meet post-discharge clinical and social needs.
  • Knowledge of clinical operations and procedures.
  • Ability to establish and maintain pro-active relationships with internal interdisciplinary team members, insurance companies, physicians, referral sources, community service organizations and health care facilities.
  • Ability to maintain quality, safety, and/or infection prevention standards.
  • Demonstrates general computer skills including data entry, word processing, email, and record management.
  • Effective organizational and time management skills.
  • Effective written and verbal communication skills.
  • Ability to maintain proper levels of confidentiality.
  • Ability to work closely and professionally with others at all levels of the organization.

Physical Requirements Over the Course of a Shift:

  • A significant amount of standing and walking.
  • Lifting/exerting of up to 25 lbs.
  • Possible exposure to bodily fluids.
  • Visual acuity required for patient assessment and documentation.
  • Acute hearing required for accurate patient assessment.
  • Sufficient manual dexterity to operate equipment and computer keyboard.
  • Close vision and the ability to adjust focus.

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