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Utilization Review Case Manager Jobs in Wisconsin

GQR

RN - Case Manager

Appleton, WI · On-site

$1.8K - $1.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Appleton, Wisconsin Start Date: September 6, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $1847 ...

GQR

RN - Case Manager

Racine, WI · On-site

$1.8K - $1.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Racine, Wisconsin Start Date: September 13, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $1832 ...

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Utilization Review Case Manager information

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$16

$36

$60

How much do utilization review case manager jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for utilization review case manager in Wisconsin is $36.83, according to ZipRecruiter salary data. Most workers in this role earn between $29.86 and $38.80 per hour, depending on experience, location, and employer.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Review Case Manager jobs in Wisconsin?

For Utilization Review Case Manager jobs in Wisconsin, the most frequently searched job titles are:

What job categories do people searching Utilization Review Case Manager jobs in Wisconsin look for?

The top searched job categories for Utilization Review Case Manager jobs in Wisconsin are:

What cities in Wisconsin are hiring for Utilization Review Case Manager jobs?

Cities in Wisconsin with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Wisconsin as of August 2026, with employment types broken down into 59% Full Time, and 41% Contract. Highlights an 100% In-person job distribution, with an average salary of $76,601 per year, or $36.8 per hour.

Utilization Management Nurse RN - Per Diem - Remote

UnitedHealth Group

Waukesha, WI • On-site, Remote

Full-time

Retirement

Posted 2 days ago

New

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

190th of 893 rated healthcare providers

Job description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Utilization Management Nurse RN is responsible for performing utilization management activities to support appropriate use of healthcare services, compliance with established medical necessity criteria, and timely coordination across the care team and payer partners. The role supports admission reviews, concurrent reviews, continued stay reviews, authorization management, denial prevention, and appeals support when appropriate.
This role is expected to operate with minimal guidance on most responsibilities, manage moderately complex work, assess needs, translate concepts into practice, and serve as a resource for others with less experience.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Perform utilization review and medical necessity assessments for inpatient admissions and continued stays
  • Conduct concurrent reviews using established clinical criteria and organizational guidelines
  • Collaborate with physicians, case managers, social workers, and interdisciplinary partners to support patient care coordination and appropriate resource utilization
  • Communicate with Medicare, Medicaid, commercial payers, and third-party reviewers regarding authorization and continued stay requirements
  • Support denial prevention activities and assist with appeals processes when appropriate
  • Apply InterQual, MCG/Milliman, or other evidence-based criteria to evaluate medical necessity
  • Maintain compliance with CMS standards and applicable regulatory requirements
  • Document utilization review activities and payer communications accurately and timely
  • Independently manage assigned workload, prioritize competing demands, and escalate complex issues when needed
  • Provide explanations, guidance, and support to team members on utilization management processes and moderately complex issues

Skills and Capabilities:
  • Demonstrated analytical, critical thinking, and problem-solving skills
  • Effective verbal and written communication skills
  • Ability to work independently with minimal guidance on routine and moderately complex responsibilities
  • Ability to assess customer needs, identify solutions to non-standard requests, and translate concepts into practice
  • Demonstrated organizational skills and ability to manage multiple priorities in a telecommuter environment

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:
  • Current, active, unrestricted Registered Nurse (RN) license in the state of Wisconsin (or Compact to include the state of Wisconsin)
  • 3+ years of professional nursing experience
  • Experience in utilization management, utilization review, case management, care coordination, medical necessity review, or a closely related clinical review function
  • Experience evaluating clinical documentation and applying judgment to support appropriate care coordination or resource utilization
  • Experience communicating with internal clinical stakeholders, payers, or external partners regarding care coordination, authorization, clinical documentation, or review outcomes
  • Ability to work any of our per diem (as needed) shift schedules during our normal business hours (8am - 4:30pm), including flexibility to work both weekday and weekend shifts

Preferred Qualifications:
  • Bachelor of Science in Nursing (BSN)
  • Utilization Management or Utilization Review experience
  • Experience supporting acute inpatient populations, concurrent review, or continued stay review
  • Experience using InterQual, MCG/Milliman, or other evidence-based medical necessity criteria
  • Experience with Medicare, Medicaid, commercial payer, managed care, authorization, or payer follow-up processes
  • Experience working successfully in a remote or telecommuter role
  • Denials management, denial prevention, or appeals support experience
  • Proven ability to serve as a clinical resource to others and provide guidance on moderately complex 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 hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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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