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Utilization Management Nurse Jobs in Appleton, WI

ThedaCare

Behavioral Health RN - Part Time

Neenah, WI · On-site

... utilization specialists, and administrative professionals. This environment allows for ... Demonstrates, anticipates, and proactively manages risk to prevent crises. 8. Performs skillfully ...

ThedaCare

Behavioral Health RN - Part Time

Neenah, WI · On-site

... utilization specialists, and administrative professionals. This environment allows for ... Demonstrates, anticipates, and proactively manages risk to prevent crises. 8. Performs skillfully ...

ThedaCare

PRN - Behavioral Health RN

Neenah, WI · On-site

... utilization specialists, and administrative professionals. This environment allows for ... Demonstrates, anticipates, and proactively manages risk to prevent crises. 8. Performs skillfully ...

ThedaCare

PRN - Behavioral Health RN

Neenah, WI · On-site

... utilization specialists, and administrative professionals. This environment allows for ... Demonstrates, anticipates, and proactively manages risk to prevent crises. 8. Performs skillfully ...

NuWest Travel Nursing

Travel RN Case Manager

Appleton, WI · On-site

$1.7K - $2.0K/wk

NuWest Travel Nursing is seeking a travel nurse RN Acute Care Case Management for a travel nursing job in Appleton, Wisconsin. & Requirements * Specialty: Acute Care Case Management * Discipline: RN ...

St. Croix Hospice

RN Case Manager

Neenah, WI · On-site

$87K - $95K/yr

Maintains accurate clinical documentation, recording pain management, symptoms, and changes in ... Nurses holding a multistate license can practice in other states without obtaining additional ...

St Croix Hospice

RN Case Manager

Neenah, WI · On-site

$87K - $95K/yr

Maintains accurate clinical documentation, recording pain management, symptoms, and changes in ... Nurses holding a multistate license can practice in other states without obtaining additional ...

St. Croix Hospice

RN Case Manager

Oshkosh, WI · On-site

In the role of Registered Nurse Case Manager , you'll be entrusted with providing 1:1, whole-person ... Educate patients and caregivers on care techniques, medications, diet, and symptom management

Eden Senior Care

MDS Coordinator

Oshkosh, WI · On-site

$80K - $90K/yr

... on managing and operating Skilled Nursing, Rehabilitation and Assisted Living communities in ... Run Utilization Review Meetings and ensure PDPM scores and rates are validated * Review and Educate ...

Moments Hospice

RN Case Manager

New London, WI · On-site

$75K - $90K/yr

As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and months as comfortable as possible. Enjoy the opportunity to work closely with the company's owners ...

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Showing results 21-40

All JobsUtilization Management Nurse JobsUtilization Management Nurse Jobs in Appleton, WI

Utilization Management Nurse information

See Appleton, WI salary details

$38.1K

$87.3K

$159K

How much do utilization management nurse jobs pay per year?

As of Aug 17, 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 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.

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:

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:

Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Appleton, WI as of August 2026, with employment types broken down into 72% Full Time, 17% Part Time, and 11% Contract. Highlights an 94% In-person, 2% Hybrid, and 4% Remote job distribution, with an average salary of $87,311 per year, or $42 per hour.

RN Supervisor - Inpatient Behavioral Health

ThedaCare

Neenah, WI • On-site

Full-time

Re-posted 22 days ago

ThedaCare rating

6.6

Company rating: 6.6 out of 10

Based on 128 frontline employees who took The Breakroom Quiz

569th of 887 rated healthcare providers

Job description

Why ThedaCare?
Living A Life Inspired!
Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world.
At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.
Benefits, with a whole-person approach to wellness -
  • Lifestyle Engagement
    • e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support

  • Access & Affordability
    • e.g. minimal or zero copays, team member cost sharing premiums, daycare

About ThedaCare!
Summary :
Job Profile Summary
The RN Clinical Supervisor provides patient-centered, specialized, and evidence-based nursing care across the continuum through an inter-professional approach to treatment, research, education, and advocacy. Contributes to the goals of the department by being accountable for the delivery of compassionate and safe care within the scope of practice as defined by the Wisconsin Board of Nursing and ThedaCare policy. Is responsible for patient outcomes that meet high quality of care standards.
Job Description:
Hours for this Supervisor role are either 10a-6p or 11a-7p M-F. Must be able to accommodate later or weekend hours as needed to meet the business operations .
UNIT DETAILS (Behavioral Health- Neenah Hospital):
This 19 bed unit serves a great purpose in the community treating various health needs. Our compassionate team is comprised of Psychiatric hospitalists, RN's, CNA's, Occupational Therapists, mental health therapists, utilization specialists, and administrative professionals. This environment allows for collaboration and learning on a daily basis. Our team is dedicated to the highest quality of care and fosters great learning opportunities.
KEY ACCOUNTABILITIES:
  • Utilizes the nursing process, evidence-based practice, and unit-specific competencies to assess the physical condition and nursing needs of patients, and develops a plan of care in a collaborative practice with the inter-professional team.
  • Monitors compliance with standards of care by observation, verbal reports, audits, and written documentation, with feedback loops to department leaders, providers, and team members.
  • Demonstrates emotional intelligence and confidence and maintains composure during conflict. Serves with integrity and sets a positive example at all times.
  • Provides input and supports the department leaders in interviewing and hiring, appraisal performance, mentoring, motivating, coaching, and retention of team members.
  • Acts strategically, understands and can manage change, and assists team members through transitions. Advocates for stakeholders to meet strategic goals, and assists team members in understanding how their day-to-day jobs contribute to organizational strategy.
  • Provides feedback to peers in a constructive manner, keeps information confidential, and develops and maintains lateral, cross-boundary relationships.
  • Plans for the total care needs of the patient in collaboration with the inter-professional team to provide the highest quality of care and clinical outcomes.
  • Demonstrates clinical expertise in the clinical specialty of assigned responsibility with the ability to perform all functions of the professional clinical nurse that are age appropriate and culturally specific.
  • Provides consultation and maintains positive relationships with physicians and other inter-professional team members, collaborating to problem solve and improve patient care.
  • Collaborates on department/clinic schedules, monitors staffing levels, and provides input to the budget preparation/monitoring and the identification of workload variability to predict and plan for appropriate staffing to enhance productivity/efficiency and maintain quality care.

QUALIFICATIONS:
  • Bachelor of Science in Nursing (BSN) or commitment to obtain BSN within five years for current ThedaCare RNs
  • Current Wisconsin RN license
  • American Heart Association Healthcare Provider Basic Life Support (BLS)
  • Three years of clinical experience
  • Two years of experience leading projects, a council/committee, and/or clinical improvement work.

PHYSICAL DEMANDS:
  • Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of Fifty (50) pounds without assistance
  • Job classification is exposed to blood borne pathogens (blood or bodily fluids) while performing job duties.

WORK ENVIRONMENT:
  • Frequent exposure to sharp objects and instruments
  • Occasional exposure to moving mechanical parts, fumes or airborne particles, toxic or caustic chemicals, and risk of electrical shock
  • Occasional high noise level in work environment
  • Possible exposure to communicable diseases, hazardous materials, and pharmacological agents
  • Standing and/or walking for extended periods of time
  • Transporting, transferring, positioning patients and/or equipment from one location to another; little likelihood for injury if proper body mechanics and procedures are followed
  • Occasional contact with aggressive and combative patients.

Position requires compliance with department specific competencies.
Scheduled Weekly Hours:
40Scheduled FTE:
1Location:
ThedaCare Regional Medical Center - Neenah - Neenah,WisconsinOvertime Exempt:
YesWorker Shift Details:
Days

What ThedaCare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About ThedaCare

Sourced by ZipRecruiter

We want to make exceptional care effortless for our patients. At ThedaCare, that means going above and beyond treating a particular condition – it means helping you achieve better health for life. You and your family are at the center of everything we do, from prioritizing your schedule when making appointments to designing our facilities for your comfort and convenience. Remaining proactive in your care allows us to better predict and prevent disease before complications arise, and when it comes to making important health-related decisions, we are here to support you. In every interaction, we want you to have full confidence the care you receive is purposeful, cost-effective and will help you continue enjoying life as you’ve planned it. ThedaCare is the third largest healthcare employer in Wisconsin, and the largest employer in Northeast Wisconsin with over 7,000 team members.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Neenah, WI, US

Year founded

1909

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