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Utilization Management Jobs in Wisconsin (NOW HIRING)

Pharmacy Careers

Remote Clinical Review Pharmacist

Madison, WI · On-site

$119K - $142K/yr

Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document recommendations and decisions according to health-plan and regulatory requirements. * Participate in ...

New

Pharmacy Careers

Remote Clinical Review Pharmacist

Milwaukee, WI · On-site

$116K - $139K/yr

Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document recommendations and decisions according to health-plan and regulatory requirements. * Participate in ...

New

Humana

Compliance UM Nurse (Wed - Sun)

Madison, WI · On-site

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

Imedica

Clinical Initiatives Business Analyst

Madison, WI · On-site

$78K - $134K/yr

Build, maintain, and enhance clinical and operational dashboards (e.g., utilization, care management performance) * Develop recurring and ad hoc reports using Excel, BI tools, SQL (Power BI, Tableau ...

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Utilization Management information

See Wisconsin salary details

$39.4K

$90.3K

$164.5K

How much do utilization management jobs pay per year?

As of Aug 11, 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 utilization management, 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 utilization management?

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 August 2026, with employment types broken down into 80% Full Time, and 20% Part Time. Highlights an 60% In-person, 20% Hybrid, and 20% Remote job distribution, with an average salary of $90,320 per year, or $43.4 per hour.

RN DENIALS MANAGEMENT HRLY, FCH - ENTERPRISE QUALITY CDI/UR/DM

Froedtert

Milwaukee, WI

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 19 days ago

Job description

Discover. Achieve. Succeed. #BeHere

Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility.

This job is REMOTE.

FTE: 0.500000

Standard Hours: 20.00

Shift: Shift 1

Shift Details: 1/2 day Wednesday, Thursday and Friday Holidays: no Weekends: no

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 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. Knowledge of ICD-10 Coding Guidelines.

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

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.

Employment Type: OTHER
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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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