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Utilization Management Coordinator Jobs in Wisconsin

Sanitas

WI · On-site

$55 - $75/hr

Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review. * Bilingual (English and Spanish) to effectively serve diverse member populations. Financial ...

Sanitas

WI · On-site

$60 - $90/hr

Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review. * Bilingual (English and Spanish) to effectively serve diverse member populations. Financial ...

Sanitas

WI · On-site

$55 - $75/hr

Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review. * Bilingual (English and Spanish) to effectively serve diverse member populations. Financial ...

Socket.dev

WI · On-site

$90 - $130/hr

Ensures members reach desired outcomes through integrated delivery and coordination of care across ... Assists in implementing care management, utilization management, behavioral health, care ...

Elevance Health

Family Care-Service Coordinator

Waukesha, WI · On-site

$19.75 - $25/hr

Family Care-Service Coordinator LTSS Service Coordinator (Case Manager) Hiring within these ... Submits utilization/authorization requests to utilization management with documentation supporting ...

Elevance Health

Family Care-Service Coordinator

Monroe, WI · Hybrid

$18.25 - $24.50/hr

LTSS Service Coordinator (Case Manager) Hiring within these Wisconsin counties: Milwaukee, Pepin ... Submits utilization/authorization requests to utilization management with documentation supporting ...

Elevance Health

Family Care-Service Coordinator

Waukesha, WI · Hybrid

$19.25 - $26/hr

LTSS Service Coordinator (Case Manager) Hiring within these Wisconsin counties: Milwaukee, Pepin ... Submits utilization/authorization requests to utilization management with documentation supporting ...

Elevance Health

Family Care-Service Coordinator

Kenosha, WI · Hybrid

$18.75 - $25.25/hr

LTSS Service Coordinator (Case Manager) Hiring within these Wisconsin counties: Milwaukee, Pepin ... Submits utilization/authorization requests to utilization management with documentation supporting ...

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Utilization Management Coordinator information

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$16

$29

$47

How much do utilization management coordinator jobs pay per hour?

As of Sep 5, 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 degree do you need for utilization management coordinator?

A utilization management coordinator typically needs at least a bachelor's degree in healthcare administration, nursing, or a related field. Relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and data analysis tools is also important.

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:

Utilization Management Coordinator jobs near you
Infographic showing various Utilization Management Coordinator job openings in Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $62,161 per year, or $29.9 per hour.

RN Coordinator Utilization Management

Network Health

Menasha, WI • On-site

Full-time

Re-posted 2 days ago

Network Health rating

7.9

Company rating: 7.9 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

187th of 315 rated insurance

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

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