Brookfield, WI · On-site +1
Experience in utilization review or case management for behavioral health is preferred * Strong communication and organization skills * Ability to work efficiently in a fast-paced environment
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Brookfield, WI · On-site +1
Experience in utilization review or case management for behavioral health is preferred * Strong communication and organization skills * Ability to work efficiently in a fast-paced environment
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 ...
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 ...
Menasha, WI · On-site +1
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 ...
Menasha, WI · On-site +1
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
... from Utilization Review and other areas. * Participates in and leads, as necessary ... Registered Nurse Case Manger Minimum Requirements: * RN Wisconsin license * 3-5 years of hospital ...
... from Utilization Review and other areas. * Participates in and leads, as necessary ... Registered Nurse Case Manger Minimum Requirements: * RN Wisconsin license * 3-5 years of hospital ...
Waukesha, WI · On-site
$30.32 - $42.11/hr
This position supports adults enrolled in Waukesha County's Targeted Case Management and CRS ... in utilization review and benefit verification the following may be substituted: a. Bachelor ...
Waukesha, WI · On-site
$30.32 - $42.11/hr
This position supports adults enrolled in Waukesha County's Targeted Case Management and CRS ... in utilization review and benefit verification the following may be substituted: a. Bachelor ...
Waukesha, WI · Hybrid
$30.32 - $42.11/hr
This position supports adults enrolled in Waukesha County's Targeted Case Management and CRS ... in utilization review and benefit verification the following may be substituted: a. Bachelor ...
Waukesha, WI · Hybrid
$30.32 - $42.11/hr
This position supports adults enrolled in Waukesha County's Targeted Case Management and CRS ... in utilization review and benefit verification the following may be substituted: a. Bachelor ...
Cudahy, WI · On-site
$19.50 - $25.25/hr
Provides case management services related to various levels of health care, finances, housing ... Documents discharge planning interventions and utilization review activity per department and ...
Cudahy, WI · On-site
$19.50 - $25.25/hr
Provides case management services related to various levels of health care, finances, housing ... Documents discharge planning interventions and utilization review activity per department and ...
$62K - $93K/yr
As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
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$62K - $93K/yr
As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
$62K - $93K/yr
As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
$62K - $93K/yr
As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Waukesha, WI · On-site
$62K - $93K/yr
As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Waukesha, WI · On-site
$62K - $93K/yr
As a RN Field Case Manager, you will make a meaningful difference in the lives of injured workers ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Milwaukee, WI · On-site
$19.75 - $25.25/hr
Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. * Develop staff schedule and revise assignments daily ...
Milwaukee, WI · On-site
$19.75 - $25.25/hr
Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. * Develop staff schedule and revise assignments daily ...
Cleveland, WI · On-site
The Case Manager works with physicians and multidisciplinary team members to develop a plan of care ... Conducts utilization reviews. * Communicates appropriate information for timely updates and ...
Cleveland, WI · On-site
The Case Manager works with physicians and multidisciplinary team members to develop a plan of care ... Conducts utilization reviews. * Communicates appropriate information for timely updates and ...
The Case Manager works with physicians and multidisciplinary team members to develop a plan of care ... Conducts utilization reviews. * Communicates appropriate information for timely updates and ...
The Case Manager works with physicians and multidisciplinary team members to develop a plan of care ... Conducts utilization reviews. * Communicates appropriate information for timely updates and ...
Milwaukee, WI · On-site
$99K/yr
Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. * Develop staff schedule and revise assignments daily ...
Milwaukee, WI · On-site
$99K/yr
Serve as content specialist for staff in the areas of utilization criteria, appeal and review process, and case management system documentation. * Develop staff schedule and revise assignments daily ...
$16.74 - $20.73
3% of jobs
$20.73 - $24.73
1% of jobs
$24.73 - $28.72
6% of jobs
$30.65 is the 25th percentile. Wages below this are outliers.
$28.72 - $32.71
30% of jobs
The median wage is $34.15 / hr.
$32.71 - $36.70
26% of jobs
$38.22 is the 75th percentile. Wages above this are outliers.
$36.70 - $40.70
22% of jobs
$40.70 - $44.69
3% of jobs
$44.69 - $48.68
0% of jobs
$48.68 - $52.67
5% of jobs
$52.67 - $56.67
2% of jobs
$56.67 - $60.66
1% of jobs
$16
$36
$60
| Aspect | Utilization Review Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license or relevant healthcare certification | Registered Nurse (RN) license is required |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinic, insurance review departments |
| Primary Focus | Reviewing medical necessity, coordinating care, managing cases | Assessing 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.
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 23 days ago
Utilization Review Specialist – Behavioral Health Facility
We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance authorizations, and collaborating with providers to support appropriate and timely care for our clients.
Responsibilities:
Conduct utilization reviews and obtain prior authorizations from insurance companies
Monitor continued stay and discharge criteria for clients
Communicate effectively with clinical and administrative teams
Maintain accurate and up-to-date documentation
Ensure all documentation meets insurance and regulatory compliance standards and is completed accurately and on time.
Qualifications:
Background or experience in social work, counseling, or behavioral health is preferred
Experience in utilization review or case management for behavioral health is preferred
Strong communication and organization skills
Ability to work efficiently in a fast-paced environment
Confident, proactive, and dedicated work ethic
Benefits: Competitive salary Opportunities for professional development and career advancement Supportive and collaborative work environment Fulfilling work helping individuals with mental health or substance abuse issues
Benefits:
401(k)
Dental insurance
Flexible schedule
Health insurance
Life insurance
Paid time off
Vision insurance
