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 ...
No Department Details Oversee health plan utilization management department operations including prior authorization, and concurrent review focusing on improving care quality and outcomes across a ...
No Department Details Oversee health plan utilization management department operations including prior authorization, and concurrent review focusing on improving care quality and outcomes across a ...
RN, Denials Management
Menomonee Falls, WI · On-site
$36.38 - $56.39/hr
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.
RN, Denials Management
Menomonee Falls, WI · On-site
$36.38 - $56.39/hr
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.
RN, Denials Management
$36.38 - $56.39/hr
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.
RN, Denials Management
$36.38 - $56.39/hr
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.
RN DENIALS MANAGEMENT HOURLY
Milwaukee, WI · On-site
$36.38 - $56.39/hr
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.
RN DENIALS MANAGEMENT HOURLY
Milwaukee, WI · On-site
$36.38 - $56.39/hr
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.
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.
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.
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise ...
Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise ...
Utilization Review Specialist-Remote
Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail ... This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance ...
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Utilization Review Specialist-Remote
Brookfield, WI · On-site +1
Utilization Review Specialist - Behavioral Health Facility We are seeking a confident, detail ... This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance ...
Region Director Care Coordination-Central Region
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
Region Director Care Coordination-Central Region
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
NP Physician Advisor
Hudson, WI · On-site
Medical Necessity Review and Utilization Management: Perform clinical reviews to assess appropriateness of level of care, admission status, and continued stay criteria in alignment with payer ...
NP Physician Advisor
Hudson, WI · On-site
Medical Necessity Review and Utilization Management: Perform clinical reviews to assess appropriateness of level of care, admission status, and continued stay criteria in alignment with payer ...
The role involves providing support and consultation for utilization management (medical and pharmacy), appeals, medical policy (development and maintenance), and quality improvement (Medicare Stars ...
The role involves providing support and consultation for utilization management (medical and pharmacy), appeals, medical policy (development and maintenance), and quality improvement (Medicare Stars ...
NP Physician Advisor
Hudson, WI · On-site
Medical Necessity Review and Utilization Management: Perform clinical reviews to assess appropriateness of level of care, admission status, and continued stay criteria in alignment with payer ...
NP Physician Advisor
Hudson, WI · On-site
Medical Necessity Review and Utilization Management: Perform clinical reviews to assess appropriateness of level of care, admission status, and continued stay criteria in alignment with payer ...
Manager, Clinical Pharmacy
Madison, WI · On-site
Utilization Management & Clinical Policy Development * Oversee custom policy writing for pharmacy and medical benefit drugs * Lead development and maintenance of UM clinical criteria, including prior ...
Manager, Clinical Pharmacy
Madison, WI · On-site
Utilization Management & Clinical Policy Development * Oversee custom policy writing for pharmacy and medical benefit drugs * Lead development and maintenance of UM clinical criteria, including prior ...
Utilization Management information
See Wisconsin salary details
$39.4K - $50.7K
15% of jobs
$50.7K - $62.1K
8% of jobs
$63.7K is the 25th percentile. Wages below this are outliers.
$62.1K - $73.5K
15% of jobs
The median wage is $80.7K / yr.
$73.5K - $84.9K
20% of jobs
$84.9K - $96.3K
11% of jobs
$101.9K is the 75th percentile. Wages above this are outliers.
$96.3K - $107.6K
13% of jobs
$107.6K - $119K
5% of jobs
$119K - $130.4K
3% of jobs
$130.4K - $141.8K
4% of jobs
$141.8K - $153.1K
3% of jobs
$153.1K - $164.5K
3% of jobs
$39.4K
$90.3K
$164.5K
How much do utilization management jobs pay per year?
As of Jul 27, 2026, the average yearly pay for utilization management in Wisconsin is $90,320.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,100.00 and $105,500.00 per year, depending on experience, location, and employer.
What are the key skills and qualifications needed to thrive in the Utilization Management position, and why are they important?
To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.
What is a Utilization Management job?
A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.
What are the typical daily responsibilities of a Utilization Management professional?
As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.
What are the most commonly searched types of Utilization Management jobs in Wisconsin? The most popular types of Utilization Management jobs in Wisconsin are:
What are popular job titles related to Utilization Management jobs in Wisconsin? For Utilization Management jobs in Wisconsin, the most frequently searched job titles are:
- Remote Utilization Review Nurse
- Remote Chart Review Nurse
- Seasonal Remote Hedis Review Nurse
- Utilization Review Nurse
- Part Time Utilization Review Nurse
- Utilization Review Specialist
- Telephonic Nurse Case Manager
- Registered Nurse Utilization Review
- Remote Utilization Management
- No Experience Utilization Review Nurse
What job categories do people searching Utilization Management jobs in Wisconsin look for? The top searched job categories for Utilization Management jobs in Wisconsin are:
What cities in Wisconsin are hiring for Utilization Management jobs? Cities in Wisconsin with the most Utilization Management 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