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Utilization Review Case Manager Jobs in Milwaukee, WI

Corvel

RN Field Case Manager I

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 ...

Corvel

RN Field Case Manager I

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 ...

CorVel Corporation

RN Field Case Manager I

Waukesha, WI · On-site

$60 - $80/hr

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 ...

UnitedHealth Group

Case Manager RN

Waukesha, WI · On-site

The Case Manager RN is responsible and accountable for coordination of patient services through an ... Knowledge of Utilization Review, Medicare Requirements processes as well as State and Federal ...

UnitedHealth Group

Case Manager RN

Waukesha, WI · On-site

The Case Manager RN is responsible and accountable for coordination of patient services through an ... Knowledge of Utilization Review, Medicare Requirements processes as well as State and Federal ...

UnitedHealth Group

Case Manager RN

Waukesha, WI · On-site

The Case Manager RN is responsible and accountable for coordination of patient services through an ... Knowledge of Utilization Review, Medicare Requirements processes as well as State and Federal ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Milwaukee, WI

Utilization Review Case Manager information

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

As of Sep 7, 2026, the average hourly pay for utilization review case manager in Milwaukee, WI is $35.95, according to ZipRecruiter salary data. Most workers in this role earn between $29.13 and $37.88 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 Milwaukee, WI?

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

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

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

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

Cities near Milwaukee, WI 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 Milwaukee, WI as of August 2026, with employment types broken down into 58% Full Time, and 42% Contract. Highlights an 100% In-person job distribution, with an average salary of $74,771 per year, or $35.9 per hour.

Managed Care Authorization Specialist

Champion Care

Milwaukee, WI • On-site

$20 - $24/hr

Other

Posted 13 days ago

Job description

Managed Care Authorization Specialist – Skilled Nursing (SNF)

$20–$24 per hour | Full-Time

Champion Care is seeking an experienced Managed Care Authorization Specialist to support our skilled nursing facilities with insurance authorizations, continued stay reviews, appeals, and payer communication.

If you have experience with managed care, insurance authorizations, utilization review, case coordination, or skilled nursing insurance processes, we want to hear from you.

This position plays an important role in keeping residents covered, preventing avoidable denials, and ensuring our facilities receive timely authorization for the care and services they provide.

What You'll Do

As a Managed Care Authorization Specialist, you will serve as a key point of contact between our skilled nursing facilities and insurance providers.

  • Manage managed care authorizations, updates, extensions, and appeals for Medicare Advantage, Medicaid managed care, and commercial insurance plans
  • Complete continued stay and concurrent reviews to support ongoing coverage
  • Review clinical documentation and facility updates to ensure payers receive the information needed for authorization decisions
  • Track admissions, re-admissions, authorization periods, and changes in condition
  • Communicate directly with insurance case managers and payer representatives regarding approvals, extensions, and coverage
  • Identify authorization issues early and follow up quickly to help prevent denials and gaps in coverage
  • Submit and manage NOMNCs, ABNs, and other required payer documentation
  • Coordinate authorizations for therapy services, equipment, and specialized care
  • Monitor payer portals and maintain accurate documentation of authorization status, reference numbers, approved days, and follow-up dates
  • Assist with denial management and appeals when additional clinical information or reconsideration is needed
  • Collaborate with nursing, therapy, admissions, business office, and facility leadership to resolve insurance and authorization issues
  • Participate in daily and weekly workflow meetings to prioritize cases and remove barriers
What We're Looking For
  • Experience with managed care authorizations, insurance authorizations, continued stay reviews, case management, or utilization review
  • Skilled nursing, long-term care, post-acute care, or healthcare experience strongly preferred
  • Knowledge of Medicare Advantage, Medicaid managed care, commercial insurance, and payer authorization processes
  • Familiarity with payer portals, clinical documentation, authorization extensions, and denial prevention
  • Ability to manage multiple residents, deadlines, and facilities while maintaining accurate documentation
  • Strong organizational skills and attention to detail
  • Ability to work with a sense of urgency and follow cases through resolution
  • Strong communication skills when working with clinical teams, facility leadership, insurance case managers, and payer representatives
Why Join Champion Care
  • Competitive pay of $20–$24 per hour
  • Full-time position within a growing multi-facility skilled nursing organization
  • High-impact role directly connected to resident coverage, denial prevention, reimbursement, and facility performance
  • Opportunity to work closely with clinical, operational, and managed care teams
  • Structured processes and support
  • Opportunity for continued professional growth within Champion Care

Champion Care is an Equal Opportunity Employer (EOE). We are committed to creating an inclusive environment for all employees and applicants and do not discriminate based on race, color, religion, sex, national origin, age, disability, genetic information, or any other protected status.

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