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Utilization Management Nurse Jobs in Wisconsin (NOW HIRING)

Accenture

Clinical Management Manager

Milwaukee, WI · On-site

$94K - $293K/yr

Minimum of 2 years of experience in care delivery operations, utilization management, or clinical performance improvement * Bachelor's Degree Preferred Qualifications: * Clinical background (RN, MD ...

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Utilization Management Nurse information

See Wisconsin salary details

$39.4K

$90.3K

$164.5K

How much do utilization management nurse jobs pay per year?

As of Aug 23, 2026, the average yearly pay for utilization management nurse in Wisconsin is $90,320.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,100.00 and $105,500.00 per year, depending on experience, location, and employer.

What is a utilization management nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

What does a utilization management nurse do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

What are the key skills and qualifications needed to thrive as a utilization management nurse?

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What are some common challenges a utilization management nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

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

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

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Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse 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 $90,320 per year, or $43.4 per hour.

Utilization Management Nurse RN - Per Diem - Remote

UnitedHealth Group

Waukesha, WI • On-site, Remote

Full-time

Retirement

Posted 2 days ago

New

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

190th of 893 rated healthcare providers

Job description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Utilization Management Nurse RN is responsible for performing utilization management activities to support appropriate use of healthcare services, compliance with established medical necessity criteria, and timely coordination across the care team and payer partners. The role supports admission reviews, concurrent reviews, continued stay reviews, authorization management, denial prevention, and appeals support when appropriate.
This role is expected to operate with minimal guidance on most responsibilities, manage moderately complex work, assess needs, translate concepts into practice, and serve as a resource for others with less experience.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Perform utilization review and medical necessity assessments for inpatient admissions and continued stays
  • Conduct concurrent reviews using established clinical criteria and organizational guidelines
  • Collaborate with physicians, case managers, social workers, and interdisciplinary partners to support patient care coordination and appropriate resource utilization
  • Communicate with Medicare, Medicaid, commercial payers, and third-party reviewers regarding authorization and continued stay requirements
  • Support denial prevention activities and assist with appeals processes when appropriate
  • Apply InterQual, MCG/Milliman, or other evidence-based criteria to evaluate medical necessity
  • Maintain compliance with CMS standards and applicable regulatory requirements
  • Document utilization review activities and payer communications accurately and timely
  • Independently manage assigned workload, prioritize competing demands, and escalate complex issues when needed
  • Provide explanations, guidance, and support to team members on utilization management processes and moderately complex issues

Skills and Capabilities:
  • Demonstrated analytical, critical thinking, and problem-solving skills
  • Effective verbal and written communication skills
  • Ability to work independently with minimal guidance on routine and moderately complex responsibilities
  • Ability to assess customer needs, identify solutions to non-standard requests, and translate concepts into practice
  • Demonstrated organizational skills and ability to manage multiple priorities in a telecommuter environment

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Current, active, unrestricted Registered Nurse (RN) license in the state of Wisconsin (or Compact to include the state of Wisconsin)
  • 3+ years of professional nursing experience
  • Experience in utilization management, utilization review, case management, care coordination, medical necessity review, or a closely related clinical review function
  • Experience evaluating clinical documentation and applying judgment to support appropriate care coordination or resource utilization
  • Experience communicating with internal clinical stakeholders, payers, or external partners regarding care coordination, authorization, clinical documentation, or review outcomes
  • Ability to work any of our per diem (as needed) shift schedules during our normal business hours (8am - 4:30pm), including flexibility to work both weekday and weekend shifts

Preferred Qualifications:
  • Bachelor of Science in Nursing (BSN)
  • Utilization Management or Utilization Review experience
  • Experience supporting acute inpatient populations, concurrent review, or continued stay review
  • Experience using InterQual, MCG/Milliman, or other evidence-based medical necessity criteria
  • Experience with Medicare, Medicaid, commercial payer, managed care, authorization, or payer follow-up processes
  • Experience working successfully in a remote or telecommuter role
  • Denials management, denial prevention, or appeals support experience
  • Proven ability to serve as a clinical resource to others and provide guidance on moderately complex issues

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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