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

AHS Vista LLC

Case Manager Full Time and PRN

Waukegan, IL · On-site

$36 - $55/hr

Coordinate the case management process , ensuring patients receive appropriate care and resources ... nurses, and other healthcare professionals to ensure smooth transitions. * Perform utilization ...

AHS Vista LLC

Case Manager Full Time and PRN

Waukegan, IL · On-site

$36 - $55/hr

Perform utilization review to assess medical necessity, care appropriateness, and compliance with ... If you are a passionate Registered Nurse with a strong background in case management and patient ...

Wellpath

Director of Nursing

Milwaukee, WI · On-site

... management, clinical precautions, infection control, fall prevention, utilization of special ... Have and maintain current licensure as a Registered Nurse within the state of employment. * Obtain ...

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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 Aug 17, 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?

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 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 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.

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.

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:

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For Utilization Management Nurse jobs in Racine, WI, the most frequently searched job titles are:

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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, 80% Full Time, 15% Part Time, and 4% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $83,906 per year, or $40.3 per hour.

Health Services Director - Remote in Wisconsin

UnitedHealth Group

Milwaukee, WI • On-site, Remote

$134K - $230K/yr

Full-time

Retirement

Posted 12 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

189th of 887 rated healthcare providers

Job description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together
This position is responsible for the management and administration of multiple Medical & Clinical Operations Functions or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family.
If you are located in Wisconsin, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
  • Provides leadership to and is accountable for the performance and direction of the Health Services team and other senior level professional staff that results in high quality healthcare and positive outcomes for our members
  • Work and responsibilities will impact the health and wellbeing of statewide membership across multiple programs and broad geographies

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:
  • Must possess one of the following:
    • Active and unrestricted RN licensure in WI
    • Licensure in Social Work
    • 8+ years of health plan experience
  • 5+ years of experience in managed care
  • 5+ years of clinical practice in a hospital, clinic, home care, or nursing home setting
  • 5+ years of experience managing direct reports, both clinical and nonclinical staff
  • Case management experience
  • Disease and utilization management experience
  • Proven ability in organization, ability to prioritize and delegate, and ability to maintain forward momentum in overall progress
  • Resident of Wisconsin

Preferred Qualifications:
  • CCM Certified
  • Experience supporting Long Term Services and Supports (LTSS)
  • Experience in policy development or policy analysis
  • Experience in contributing to the overall health plan strategy that achieves business objectives and support efforts towards affordability goals
  • Proven to display a high degree of organization, ability to prioritize and delegate, and ability to maintain forward momentum in overall progress
  • Demonstrate critical leadership and management skills that develop positive working relationships with staff, with an emphasis on empowerment and positive motivation
  • Demonstrate solid written and verbal communication skills
  • Demonstrate the ability to work with all levels of key stakeholders, from member-facing front line staff to CEO, and national UHC leaders
  • Demonstrate ability to clearly present to, and communicate with, state partners to support clinical and system thought leadership and to identify, address and resolve potential 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 salary for this role will range from $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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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