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Utilization Management Jobs in Wisconsin (NOW HIRING)

Blue Cross Blue Shield of Nebraska

WI · On-site

Blue Cross Blue Shield of Nebraska is seeking a Senior Medical Director for Utilization Management, responsible for leadership in managing utilization programs. This role requires a Doctor of ...

Froedtert

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.

Froedtert

RN UTILIZATION REVIEW

Menomonee Falls, WI · On-site

$34 - $52.70/hr

Prior utilization management or case management experience is required. A minimum of 5 years of acute care nursing experience is preferred. Utilization of Interqual, MCG care web QI or Indicia ...

Blue Cross Blue Shield of Nebraska

WI · On-site

The Senior Medical Director, Utilization Management is the physician leader accountable for strategic and operational leadership of utilization management (UM) programs across commercial, ACA, and/or ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Madison, WI · On-site +1

$57.75 - $70.25/hr

Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:

Pharmacy Careers

Appeals Pharmacist (Remote)

Milwaukee, WI · On-site +1

$56.50 - $68.75/hr

Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:

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All JobsUtilization Management JobsUtilization Management Jobs in Wisconsin

Utilization Management information

See Wisconsin salary details

$39.4K

$90.3K

$164.5K

How much do utilization management jobs pay per year?

As of Jul 6, 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:
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:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Wisconsin as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $90,320 per year, or $43.4 per hour.
RN Coordinator Utilization Management

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Posted 2 hours ago

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
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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