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Utilization Management Nurse Jobs in Racine, WI (NOW HIRING)

FROEDTERT HEALTH

RN, Denials Management

Menomonee Falls, WI · On-site

$36.38 - $56.39/hr

Prior utilization management, insurance background, and denial management experience is preferred. EDUCATION DESCRIPTION: Bachelor's degree is required. Professional knowledge of nursing theory and ...

FROEDTERT HEALTH

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

Prior utilization management, insurance background, and denial management experience is preferred. EDUCATION DESCRIPTION: Bachelor's degree is required. Professional knowledge of nursing theory and ...

Froedtert

RN, Denials Management

Menomonee Falls, WI

$36.38 - $56.39/hr

Prior utilization management, insurance background, and denial management experience is preferred. EDUCATION DESCRIPTION: Bachelor's degree is required. Professional knowledge of nursing theory and ...

Advocate Aurora Health

Case Manager

Cudahy, WI · On-site

$19.50 - $25.25/hr

Registered Nurse License issued by the state in which the Team Member practices. Level of Education ... Ability to apply elements of Utilization Management programs. Physical REQUIREMENTS Must be able to ...

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

Utilization Management Nurse information

See Racine, WI salary details

$36.6K

$83.9K

$152.8K

How much do utilization management nurse jobs pay per year?

As of Jul 27, 2026, the average yearly pay for utilization management nurse in Racine, WI is $83,906.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,500.00 and $98,000.00 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?

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.

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 Racine, WI? The most popular types of Utilization Management Nurse jobs in Racine, WI are:
What are popular job titles related to Utilization Management Nurse jobs in Racine, WI? For Utilization Management Nurse jobs in Racine, WI, the most frequently searched job titles are:
What job categories do people searching Utilization Management Nurse jobs in Racine, WI look for? The top searched job categories for Utilization Management Nurse jobs in Racine, WI are:
What cities near Racine, WI are hiring for Utilization Management Nurse jobs? Cities near Racine, WI with the most Utilization Management Nurse job openings:
Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Racine, WI as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $83,906 per year, or $40.3 per hour.
RN, Denials Management

RN, Denials Management

FROEDTERT HEALTH

Menomonee Falls, WI • On-site

$36.38 - $56.39/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Job description

Discover. Achieve. Succeed. #BeHere
Location: US:WI:MENOMONEE FALLS at our WOODLAND PRIME 400 facility.
This job is REMOTE.
FTE: 1.000000
Standard Hours: 40.00
Shift: Shift 1
Shift Details: No holidays or weekends
Job Summary:
Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation 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 recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.
EXPERIENCE DESCRIPTION:
A minimum of 5 years of acute care nursing experience or 5 years nursing with relevant denials/appeals experience is required. Prior utilization management, insurance background, and denial management experience is preferred.
EDUCATION DESCRIPTION:
Bachelor's degree is required. Professional knowledge of nursing theory and practice at a level normally acquired through completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse is required.
TRAINING DESCRIPTION:
Previous experience with clinical validation denial review and appeal processes, preferred. Knowledge of ICD-10 Coding Guidelines is preferred.
SPECIAL SKILLS DESCRIPTION:
Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel. Analytical skills necessary to prepare statistical reports and develop solutions to problems. Technical writing ability for appeal letters and reports.
LICENSURE DESCRIPTION:
Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).
Compensation, Benefits & Perks at Froedtert Health
Pay is expected to be between: (expressed as hourly) $36.38 - $56.39. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.
Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:
  • Paid time off
  • Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
  • Academic Partnership with the Medical College of Wisconsin
  • Referral bonuses
  • Retirement plan - 403b
  • Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
  • Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.
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About Froedtert

Sourced by ZipRecruiter

Froedtert is a world-class healthcare organization based in Milwaukee, WI, United States. The company operates within the healthcare and wellness industry, providing a broad spectrum of medical services to the residents of southeastern Wisconsin and beyond. Froedtert was founded in 1980 and is an academic health network, which ripples an integrated affiliation with the Medical College of Wisconsin. The company prides itself on its cutting-edge treatments, sophisticated technology, and groundbreaking research. Froedtert’s mission is to advance health in the communities they serve, with a profound commitment towards patient care, education, research and community outreach.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Milwaukee, WI, US

Year founded

1980

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