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 ...
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 ...
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 ...
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 ...
Maintains highly effective inpatient discharge planning, utilization management, and communication ... Active license as RN, APSW, or other clinically relevant healthcare professional. * Current ...
Maintains highly effective inpatient discharge planning, utilization management, and communication ... Active license as RN, APSW, or other clinically relevant healthcare professional. * Current ...
RN Care Manager
Menasha, WI · Remote
The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · Remote
The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · Remote
The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · Remote
The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · On-site
Description The Registered Nurse Care Manager provides case management services that are member ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · On-site
Description The Registered Nurse Care Manager provides case management services that are member ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · On-site +1
The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · On-site +1
The Registered Nurse Care Manager provides case management services that are member-centric and ... Previous experience in case management, utilization management, insurance, or managed care ...
... (RN) - Skilled Nursing Facility in Little Chute, WI North Shore Health prioritizes award-winning ... coverage while managing labor costs, overtime, and agency utilization * Ensures orientation ...
... (RN) - Skilled Nursing Facility in Little Chute, WI North Shore Health prioritizes award-winning ... coverage while managing labor costs, overtime, and agency utilization * Ensures orientation ...
Director of Nursing (DON) - Full-Time Exempt
Little Chute, WI · On-site
$120K/yr
... (RN) - Skilled Nursing Facility in Little Chute, WI North Shore Health prioritizes award-winning ... coverage while managing labor costs, overtime, and agency utilization * Ensures orientation ...
Director of Nursing (DON) - Full-Time Exempt
Little Chute, WI · On-site
$120K/yr
... (RN) - Skilled Nursing Facility in Little Chute, WI North Shore Health prioritizes award-winning ... coverage while managing labor costs, overtime, and agency utilization * Ensures orientation ...
Registered Nurse (RN)
Oshkosh, WI · On-site
$55 - $60/hr
Infirmary Management: Monitor, evaluate, and provide dedicated care to complex patients housed ... Prior professional experience navigating behavioral health, substance utilization programs, or ...
Quick apply
Registered Nurse (RN)
Oshkosh, WI · On-site
$55 - $60/hr
Infirmary Management: Monitor, evaluate, and provide dedicated care to complex patients housed ... Prior professional experience navigating behavioral health, substance utilization programs, or ...
Operations Manager
Green Bay, WI · Hybrid
Shared participation in the Administrator On-Call rotation * 1-2 holidays per year What You'll Do Labor & Workforce Management * Lead labor utilization and productivity initiatives across nursing ...
Operations Manager
Green Bay, WI · Hybrid
Shared participation in the Administrator On-Call rotation * 1-2 holidays per year What You'll Do Labor & Workforce Management * Lead labor utilization and productivity initiatives across nursing ...
Registered Nurse (RN)
Green Bay, WI · On-site
$55 - $63/hr
Infirmary Management: Monitor, evaluate, and provide dedicated care to complex patients housed ... Prior professional experience navigating behavioral health, substance utilization programs, or ...
Quick apply
Registered Nurse (RN)
Green Bay, WI · On-site
$55 - $63/hr
Infirmary Management: Monitor, evaluate, and provide dedicated care to complex patients housed ... Prior professional experience navigating behavioral health, substance utilization programs, or ...
... utilization specialists, and administrative professionals. This environment allows for ... Acts strategically, understands and can manage change, and assists team members through transitions.
... utilization specialists, and administrative professionals. This environment allows for ... Acts strategically, understands and can manage change, and assists team members through transitions.
... the administration and management of chemotherapy and biotherapy, and utilizing an ... demonstrated utilization of TQM and research principles, critical thinking, and excellent ...
... the administration and management of chemotherapy and biotherapy, and utilizing an ... demonstrated utilization of TQM and research principles, critical thinking, and excellent ...
Utilization Management Nurse information
See Appleton, WI salary details
$38.1K - $49.1K
15% of jobs
$49.1K - $60.1K
8% of jobs
$61.6K is the 25th percentile. Wages below this are outliers.
$60.1K - $71.1K
15% of jobs
The median wage is $78K / yr.
$71.1K - $82K
20% of jobs
$82K - $93K
11% of jobs
$98.5K is the 75th percentile. Wages above this are outliers.
$93K - $104K
13% of jobs
$104K - $115K
5% of jobs
$115K - $126K
3% of jobs
$126K - $137K
4% of jobs
$137K - $148K
3% of jobs
$148K - $159K
3% of jobs
$38.1K
$87.3K
$159K
How much do utilization management nurse jobs pay per year?
As of Jul 27, 2026, the average yearly pay for utilization management nurse in Appleton, WI is $87,311.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,900.00 and $102,000.00 per year, depending on experience, location, and employer.
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 are the key skills and qualifications needed to thrive as a Utilization Management Nurse, and why are they important?
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 does a utilization management nurse do?
A utilization management nurse reviews medical records and treatment plans to determine if healthcare services meet insurance or clinical guidelines for necessity and appropriateness. They collaborate with healthcare providers and insurance companies to approve, modify, or deny coverage, often using electronic health records and adhering to regulatory standards. Certification in case management or utilization review is common in this role.
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.
How to make an extra 2000 a month as a nurse?
Utilization Management Nurses can increase their income by taking on additional part-time or per diem shifts, especially in high-demand settings. Developing specialized skills or certifications, such as case management or health informatics, can also qualify them for higher-paying roles or consulting opportunities outside regular hours.
What is the difference between Utilization Management Nurse vs Case Manager?
| Aspect | Utilization Management Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, case management certification often preferred |
| Work Environment | Insurance companies, healthcare organizations, utilization review departments | Hospitals, community health agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of services | Coordinating 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.
How to make 150,000 as a nurse?
A Utilization Management Nurse can earn $150,000 by gaining extensive experience, obtaining advanced certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or specialty healthcare organizations. Developing strong analytical skills and understanding healthcare policies can also enhance earning potential, often requiring a master's degree or specialized training. Salary varies based on location, employer, and level of expertise.
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.
How to get into utilization management as a nurse?
To become a utilization management nurse, candidates typically need a registered nurse (RN) license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can improve job prospects, and strong knowledge of healthcare policies and documentation is essential.
More about Utilization Management Nurse jobs
What are the most commonly searched types of Utilization Management Nurse jobs in Appleton, WI? The most popular types of Utilization Management Nurse jobs in Appleton, WI are:
What are popular job titles related to Utilization Management Nurse jobs in Appleton, WI? For Utilization Management Nurse jobs in Appleton, WI, the most frequently searched job titles are:
- Remote Chart Review Nurse
- No Experience Utilization Review Nurse
- Remote Utilization Review Nurse
- Contract Hedis Review Nurse
- Freelance Utilization Review Nurse
- Temporary Utilization Review Nurse
- Remote Utilization Review Rn
- Remote Utilization Management Nurse
- Remote Utilization Management
- Night Utilization Review Nurse
What job categories do people searching Utilization Management Nurse jobs in Appleton, WI look for? The top searched job categories for Utilization Management Nurse jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Utilization Management Nurse jobs? Cities near Appleton, WI with the most Utilization Management Nurse job openings:
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