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Utilization Review Case Manager Jobs in Madison, WI

The Salvation Army

Case Manager II - Housing

Madison, WI

$21 - $25.25/hr

Reviews all assigned cases on a scheduled basis to determine continuing need for services and participate in case consultations. * Provides training to new case managers. * Regularly peer review and ...

SSM Health

Registered Nurse - Case Manager

Madison, WI · On-site

May also be responsible for: utilization management process, ED case management process, admission process, and act as a case manager liaison with post acute providers (skilled nursing facilities ...

Imedica

Supervisor, Case Management

Madison, WI · On-site

Support the Manager in defining and applying performance standards to monitor staff effectiveness ... Members are supported in transitions of care in order to improve outcomes and decrease utilization.

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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 24, 2026, the average hourly pay for utilization review case manager in Madison, WI is $36.77, according to ZipRecruiter salary data. Most workers in this role earn between $29.81 and $38.75 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 Madison, WI?

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

What job categories do people searching Utilization Review Case Manager jobs in Madison, WI look for?

The top searched job categories for Utilization Review Case Manager jobs in Madison, WI are:

What cities near Madison, WI are hiring for Utilization Review Case Manager jobs?

Cities near Madison, WI with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you

Case Manager - Inpatient Rehab

Select Medical

Madison, WI

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 10 days ago

Job description

Select Medical Madison Rehabilitation Hospital

*A joint venture with Select Medical & Hospital*

Madison, Wisconsin

 

Case Manager (RN, SW, RT, LPN) 

M-F 8HR Shifts *As Needed Basis*

Why Join Us?

  • Start Strong: Extensive and thorough orientation program to ensure a smooth transition into our setting
  • Recharge & Refresh: Generous PTO and Paid Sick Time for full-time team members to maintain a healthy work-life balance
  • Your Health Matters: Comprehensive medical/RX, health, vision, employee assistance program (EAP) and dental plan offerings for full-time team members
  • Invest in Your Future: Company-matching 401(k) retirement plan, as well as life and disability protection for full-time team members
  • Your Impact Matters: Join a team of over 44,000 committed to providing exceptional patient care

Position Summary

The Case Manager is responsible for the coordination of health care decisions by using a systematic approach to assure treatment plans that improve quality and outcomes, coordination of care across the continuum; promotion of cost-effective care within the allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the discharge planning process.

The primary job functions in Case Management include:

  • Clinical Interventions/Discharge Planning
  • Care Planning Management
  • Fiscal Management
  • Payer/Referral Management

Minimum Qualifications

  • Current Licensure per sate guidelines in a clinical or related discipline OR a Bachelor's or Master's in health or human services discipline. 

Previous Experience 

  • Previous experience in Case Management and Discharge Planning preferred.
  • CCM Certification Preferred.

Equal Opportunity Employer/including Disabled/Veterans

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