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 ...
RN Coordinator Utilization Management
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 ...
RN Coordinator Utilization Management
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 ...
Case Manager
New London, WI · On-site
... review meetings with parents and social workers; working collaboratively with internal care ... Provides case management to support residents by developing treatment plans and aftercare ...
Case Manager
New London, WI · On-site
... review meetings with parents and social workers; working collaboratively with internal care ... Provides case management to support residents by developing treatment plans and aftercare ...
Residential Case Manager
Appleton, WI · On-site
$22 - $26/hr
The Residential Case Manager provides case management, program management, staff supervision, and ... Applications are actively retained & reviewed for current and/or future openings for 60 days.
Quick apply
Residential Case Manager
Appleton, WI · On-site
$22 - $26/hr
The Residential Case Manager provides case management, program management, staff supervision, and ... Applications are actively retained & reviewed for current and/or future openings for 60 days.
Residential Case Manager
Appleton, WI · On-site
$22 - $26/hr
The Residential Case Manager provides case management, program management, staff supervision, and ... Applications are actively retained & reviewed for current and/or future openings for 60 days.
Residential Case Manager
Appleton, WI · On-site
$22 - $26/hr
The Residential Case Manager provides case management, program management, staff supervision, and ... Applications are actively retained & reviewed for current and/or future openings for 60 days.
RN Case Manager
Oshkosh, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
Quick apply
RN Case Manager
Oshkosh, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
RN Case Manager
Neenah, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
Quick apply
RN Case Manager
Neenah, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
RN Case Manager
Appleton, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
Quick apply
RN Case Manager
Appleton, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
RN Case Manager
Green Bay, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
Quick apply
RN Case Manager
Green Bay, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
RN Case Manager
De Pere, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
Quick apply
RN Case Manager
De Pere, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
RN Case Manager
Omro, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
Quick apply
RN Case Manager
Omro, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
RN Case Manager
New London, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
Quick apply
RN Case Manager
New London, WI · On-site
$75K - $90K/yr
As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...
MDS Coordinator
Oshkosh, WI · On-site
$80K - $90K/yr
... case managers * ICD 10 coding for all new admissions and continual updating for LTC population ... Run Utilization Review Meetings and ensure PDPM scores and rates are validated * Review and Educate ...
Quick apply
MDS Coordinator
Oshkosh, WI · On-site
$80K - $90K/yr
... case managers * ICD 10 coding for all new admissions and continual updating for LTC population ... Run Utilization Review Meetings and ensure PDPM scores and rates are validated * Review and Educate ...
RN Care Manager
Menasha, WI · On-site +1
Review results from medical or behavioral tests and procedures and updates care plan to reflect ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · On-site +1
Review results from medical or behavioral tests and procedures and updates care plan to reflect ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · On-site
Review results from medical or behavioral tests and procedures and updates care plan to reflect ... Previous experience in case management, utilization management, insurance, or managed care ...
RN Care Manager
Menasha, WI · On-site
Review results from medical or behavioral tests and procedures and updates care plan to reflect ... Previous experience in case management, utilization management, insurance, or managed care ...
Utilization Review Case Manager information
See Appleton, WI salary details
$16.18 - $20.04
3% of jobs
$20.04 - $23.90
1% of jobs
$23.90 - $27.76
6% of jobs
$29.63 is the 25th percentile. Wages below this are outliers.
$27.76 - $31.62
30% of jobs
The median wage is $33.01 / hr.
$31.62 - $35.48
26% of jobs
$36.95 is the 75th percentile. Wages above this are outliers.
$35.48 - $39.34
22% of jobs
$39.34 - $43.20
3% of jobs
$43.20 - $47.06
0% of jobs
$47.06 - $50.92
5% of jobs
$50.92 - $54.78
2% of jobs
$54.78 - $58.64
1% of jobs
$16
$35
$58
How much do utilization review case manager jobs pay per hour?
As of Aug 7, 2026, the average hourly pay for utilization review case manager in Appleton, WI is $35.60, according to ZipRecruiter salary data. Most workers in this role earn between $28.85 and $37.55 per hour, depending on experience, location, and employer.
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 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 is the difference between Utilization Review Case Manager vs Utilization Review Nurse?
| 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.
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 are popular job titles related to Utilization Review Case Manager jobs in Appleton, WI? For Utilization Review Case Manager jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Appleton, WI look for? The top searched job categories for Utilization Review Case Manager jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Utilization Review Case Manager jobs? Cities near Appleton, WI with the most Utilization Review Case Manager 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.Â
Location:Â 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:Â 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