The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
RN Coordinator Utilization Management
Menasha, WI · On-site +1
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
RN Coordinator Utilization Management
Menasha, WI · On-site +1
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
Join us in creating a community of connected care, where coordinated, quality service is the norm ... This role oversees utilization management projects, initiates and participates in quality ...
Join us in creating a community of connected care, where coordinated, quality service is the norm ... This role oversees utilization management projects, initiates and participates in quality ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
Description The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews ...
Description The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews ...
Supervisor, Utilization Management - Ops Medica is a nonprofit health plan with more than a million ... Join us in creating a community of connected care, where coordinated, quality service is the norm ...
Supervisor, Utilization Management - Ops Medica is a nonprofit health plan with more than a million ... Join us in creating a community of connected care, where coordinated, quality service is the norm ...
Join us in creating a community of connected care, where coordinated, quality service is the norm ... The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ...
Join us in creating a community of connected care, where coordinated, quality service is the norm ... The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ...
Join us in creating a community of connected care, where coordinated, quality service is the norm ... The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ...
Join us in creating a community of connected care, where coordinated, quality service is the norm ... The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ...
Join us in creating a community of connected care, where coordinated, quality service is the norm ... The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ...
Join us in creating a community of connected care, where coordinated, quality service is the norm ... The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ...
Disease Management Coordinator
Whitehall, WI · On-site
Other duties may be assigned. 1. Ambulatory Utilization Management, Financial Management and ... Coordinates appropriate laboratory and diagnostic testing. 12. Continuously evaluates laboratory ...
Disease Management Coordinator
Whitehall, WI · On-site
Other duties may be assigned. 1. Ambulatory Utilization Management, Financial Management and ... Coordinates appropriate laboratory and diagnostic testing. 12. Continuously evaluates laboratory ...
Union Position: No Department Details Oversee health plan utilization management department ... Coordinates authorization/certification of care for designated populations to establish medical ...
Union Position: No Department Details Oversee health plan utilization management department ... Coordinates authorization/certification of care for designated populations to establish medical ...
RN, Denials Management
Menomonee Falls, WI · On-site
$36.38 - $56.39/hr
... audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides ...
RN, Denials Management
Menomonee Falls, WI · On-site
$36.38 - $56.39/hr
... audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides ...
... audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides ...
... audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... Manage day-to-day engagement delivery, including workplans, team coordination, deliverable quality ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... Manage day-to-day engagement delivery, including workplans, team coordination, deliverable quality ...
Case Mgmt Care Coord Assoc
Milwaukee, WI · On-site
Job Summary: Coordinates transitional care and discharge planning for hospitalized children ... Cross trained in the functions of the case management assistant and utilization management ...
Case Mgmt Care Coord Assoc
Milwaukee, WI · On-site
Job Summary: Coordinates transitional care and discharge planning for hospitalized children ... Cross trained in the functions of the case management assistant and utilization management ...
Region Director Care Coordination-Central Region
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention ... promoting coordination of care across acute and post-acute settings; Develops strong working ...
Region Director Care Coordination-Central Region
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention ... promoting coordination of care across acute and post-acute settings; Develops strong working ...
Family Care-Service Coordinator
Milwaukee, WI · Hybrid
$19.75 - $26/hr
Family Care-Service Coordinator LTSS Service Coordinator (Case Manager) Hiring near: Milwaukee ... Submits utilization/authorization requests to utilization management with documentation supporting ...
Family Care-Service Coordinator
Milwaukee, WI · Hybrid
$19.75 - $26/hr
Family Care-Service Coordinator LTSS Service Coordinator (Case Manager) Hiring near: Milwaukee ... Submits utilization/authorization requests to utilization management with documentation supporting ...
Utilization Management Coordinator information
See Wisconsin salary details
$16.01 - $18.84
7% of jobs
$21.43 is the 25th percentile. Wages below this are outliers.
$18.84 - $21.66
19% of jobs
$21.66 - $24.48
22% of jobs
The median wage is $24.77 / hr.
$24.48 - $27.31
11% of jobs
$27.31 - $30.13
4% of jobs
$30.13 - $32.95
5% of jobs
$34.15 is the 75th percentile. Wages above this are outliers.
$32.95 - $35.78
14% of jobs
$35.78 - $38.60
10% of jobs
$38.60 - $41.42
4% of jobs
$41.42 - $44.25
2% of jobs
$44.25 - $47.07
1% of jobs
$16
$29
$47
How much do utilization management coordinator jobs pay per hour?
As of Aug 16, 2026, the average hourly pay for utilization management coordinator in Wisconsin is $29.89, according to ZipRecruiter salary data. Most workers in this role earn between $21.59 and $34.95 per hour, depending on experience, location, and employer.
What does a utilization management coordinator do?
A Utilization Management Coordinator is responsible for reviewing and assessing healthcare services to ensure that patients receive appropriate care while managing costs for healthcare providers or insurance companies. They evaluate medical records, coordinate with healthcare professionals, and help determine if certain treatments or procedures are medically necessary according to established guidelines. Their goal is to optimize the use of healthcare resources, prevent unnecessary treatments, and support quality patient outcomes.
What are the key skills and qualifications needed to thrive as a utilization management coordinator?
To thrive as a Utilization Management Coordinator, you need a background in healthcare or nursing, knowledge of medical terminology, and experience in case management or utilization review, often supported by a relevant degree or certification (such as RN or LPN). Familiarity with utilization management software, electronic health records (EHRs), and insurance authorization platforms is typically required. Strong organizational skills, attention to detail, and effective communication are essential soft skills for this role. These capabilities ensure accurate review of medical cases, compliance with regulations, and efficient coordination between providers, payers, and patients.
How does a utilization management coordinator typically collaborate with clinical staff and insurance providers?
A Utilization Management Coordinator serves as a vital link between healthcare providers, clinical staff, and insurance companies. They regularly communicate with physicians and nurses to gather clinical information, review treatment plans, and ensure that proposed services meet medical necessity criteria. Coordinators also interact with insurance providers to obtain pre-authorizations, clarify coverage policies, and appeal denied claims when appropriate. Effective collaboration and strong communication skills are essential, as the role requires balancing the needs of patients, providers, and payers while ensuring timely and cost-effective care.
What are the most commonly searched types of Utilization Management jobs in Wisconsin?
The most popular types of Utilization Management jobs in Wisconsin are:
What are popular job titles related to Utilization Management Coordinator jobs in Wisconsin?
For Utilization Management Coordinator jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Utilization Management Coordinator jobs in Wisconsin look for?
The top searched job categories for Utilization Management Coordinator jobs in Wisconsin are:
- Freelance Speech Therapy Utilization Review
- Transplant Case Manager
- Prior Authorization Utilization Review
- Coordinator Hospital Risk
- Dental Utilization Review
- Remote Aetna Utilization Review
- Lpn Utilization Review Work From Home
- Temporary Aetna Utilization Review Nurse
- Remote Optum Utilization Review
- Authorization Utilization Review Bcba
Job description
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.
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. Training is required in person at our Menasha location for the first 6-8 weeks.
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:
- Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
- Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
- Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
- Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
- Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
- Collaborate with other NH departments to develop interdepartmental operational processes
- Support Utilization Management department programs and goals through active participation
- Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
- Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
- Evaluate cases for cost savings/quality improvement potential
- Other duties and responsibilities as assigned
Job Requirements:
- Bachelor of Science in Nursing, preferred
- Associate Degree in Nursing, required
- Current registered nurse licensure in Wisconsin required
- Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
- Experience in insurance, managed care and utilization management preferred
Network Health is an Equal Opportunity Employer
About Network Health
Sourced by ZipRecruiter
Industry
Insurance services
Company size
201 - 500 Employees
Headquarters location
Menasha, WI, US
Year founded
1982