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

divvyDOSE

RN Home | , | Group

Gurnee, IL · On-site

$45.71 - $68.56/hr

Registered Nurse In Home Health Explore opportunities with Illinois Home Health, a part of LHC ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UMR

RN Home | , | Group

Gurnee, IL · On-site

$45.71 - $68.56/hr

Registered Nurse In Home Health Explore opportunities with Illinois Home Health, a part of LHC ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

Genoa Telepsychiatry

RN Home | , | Group

Gurnee, IL · On-site

$45.71 - $68.56/hr

Registered Nurse In Home Health Explore opportunities with Illinois Home Health, a part of LHC ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealthcare

RN Home | , | Group

Gurnee, IL · On-site

$45.71 - $68.56/hr

Registered Nurse In Home Health Explore opportunities with Illinois Home Health, a part of LHC ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealth Group

RN Home Health

Gurnee, IL · On-site

$45.71 - $68.56/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealth Group

RN Home Health

Gurnee, IL

$45.71 - $68.56/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

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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 Sep 6, 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 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 Racine, WI?

The most popular types of Utilization Management Nurse jobs in Racine, WI 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 August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 16% Part Time, 2% Contract, and 3% Nights. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $83,906 per year, or $40.3 per hour.

Integrated Case Manager

Children's Wisconsin

Milwaukee, WI • On-site

Part-time

Re-posted 3 days ago

Children's Wisconsin rating

7.6

Company rating: 7.6 out of 10

Based on 66 frontline employees who took The Breakroom Quiz

261st of 1,065 rated hospitals

Job description

At Children's Wisconsin, we believe kids deserve the best.
Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.
We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.
Please follow this link for a closer look at what it's like to work at Children's Wisconsin: https://www.instagram.com/lifeatcw/
Job Summary:
Utilizing the case management process, the Integrated Case Manager the (ICM) coordinates transitional care for the children/families for an assigned medical team. Responsible for effective coordination of care, the ICM collaborates with providers to assure all patient stays meet the needs of the patient to discharge in a safe and efficient manner. In addition, based on the needs of the department also performs the functions of a Hospital Case Manager (HCM).
Essential Functions:
  • Understands and satisfies the continued needs of the neonate, infant, toddler, pre-school, school-age, adolescent and/or young adult patient in regard to their growth and development as they transition home or to an alternate level of care.
  • Demonstrates teamwork within the department by assisting other staff members as necessary.
  • Integrated Case Manager * Initial and ongoing assessment of the patient's clinical situation and inclusive of their physical and behavioral needs. * Leads the implementation and management of a care coordination plan by collaborating with members of the care coordination team, family/care givers, treating providers, hospitals and other facilities, community agencies and services. Attends all patient rounds with assigned Provider teams. Documents all acute care admissions as avoidable potential denials when InterQual criteria are not met. * Documents all length of stay concerns as avoidable potential denials. * Collaborates with Providers on the attending team to discuss differences in LOC assignment. Uses clinical protocols, algorithms, paths, if available and applicable. * Ensures that patients receive appropriate services across the continuum of care and continuity of care across service levels and among providers. * Provides or arranges outreach calls or visits to patients to insure appropriate delivery and access to aftercare services. * Communicates self-pays and out-of network payors to financial clearance department. * Provide education to families about outpatient/observation level of care and potential co pays.
  • Hospital Case Manager * Performs all the functions of the Hospital

Education:
  • Associate's Degree Nursing required
  • Bachelor's Degree Nursing preferred

Experience:
  • 2+ years Minimum of 2-3 years of case management experience preferred
  • Previous experience in pediatrics, discharge planning, home care, and/or other care of the child/family preferred

Knowledge, Skills and Abilities:
  • Independent judgment, analytical ability, systems thinking and highest level of interpersonal communications to work effectively in complex systems.
  • Able to collect pertinent clinical information while maintaining a good rapport and relationship with providers.
  • Considerable skill in interpreting clinical treatment information resulting in successful linking of patients with providers and resources throughout the continuum of care.
  • Expertise in Utilization Management and understanding of InterQual criteria preferred.
  • Computer knowledge and skills in WORD, Outlook, Excel and Internet use.
  • Ability to learn and navigate hospital specific programs such as Origami, Epic and Electronic Health Records.
  • An understanding of the impact of healthcare delivery systems on the patient and family.
  • Knowledge of patient care, case management theory and practice preferred.

Licenses and Certifications:
  • License RN-Registered Nurse (30) - State of Wisconsin required
  • ANCC certification or CCM-Certified Case Manager - Commission for Case Manager Certification preferred

Patient Care Responsibility:
  • Provides care appropriate to patient population and as described in applicable policies and procedures.

Required for All Jobs:
  • This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that may be requested in the performance of this job.
  • Employment is at-will. This document does not create an employment contract, implied or otherwise.

Hours: 8A-4:30
Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.
Certifications/Licenses:
License RN-Registered Nurse (30) - State of Wisconsin

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