The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
WI · On-site
$75 - $105/hr
The Inpatient Utilization Review RN also assists with care coordination and discharge planning activities to support efficient patient progression throughout the continuum of care. Responsibilities ...
New
WI · On-site
$75 - $105/hr
The Inpatient Utilization Review RN also assists with care coordination and discharge planning activities to support efficient patient progression throughout the continuum of care. Responsibilities ...
New
The Inpatient Utilization Review RN also assists with care coordination and discharge planning activities to support efficient patient progression throughout the continuum of care. Responsibilities ...
Quick apply
The Inpatient Utilization Review RN also assists with care coordination and discharge planning activities to support efficient patient progression throughout the continuum of care. Responsibilities ...
The Inpatient Utilization Review RN also assists with care coordination and discharge planning activities to support efficient patient progression throughout the continuum of care. Responsibilities ...
Quick apply
The Inpatient Utilization Review RN also assists with care coordination and discharge planning activities to support efficient patient progression throughout the continuum of care. Responsibilities ...
The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ... central point of contact for operational issue identification, escalation, and resolution. This ...
The Supervisor, Utilization Management - Ops oversees a team of Review Coordinators who serve as a ... central point of contact for operational issue identification, escalation, and resolution. This ...
Clinical Reviewer - Portland, Oregon
Oregon, WI · On-site
$75 - $90/hr
... coordination that connects children, youth, and adults to in-home and community-based care. You ... Ability to document utilization review determinations accurately and timely in designated systems
New
Clinical Reviewer - Portland, Oregon
Oregon, WI · On-site
$75 - $90/hr
... coordination that connects children, youth, and adults to in-home and community-based care. You ... Ability to document utilization review determinations accurately and timely in designated systems
New
Clinical Reviewer - Eugene, Oregon
Oregon, WI · On-site
$75 - $90/hr
... coordination that connects children, youth, and adults to in-home and community-based care. You ... Ability to document utilization review determinations accurately and timely in designated systems
New
Clinical Reviewer - Eugene, Oregon
Oregon, WI · On-site
$75 - $90/hr
... coordination that connects children, youth, and adults to in-home and community-based care. You ... Ability to document utilization review determinations accurately and timely in designated systems
New
WI · On-site
$60 - $90/hr
Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review. * Bilingual (English and Spanish) to effectively serve diverse member populations. Financial ...
New
WI · On-site
$55 - $75/hr
Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review. * Bilingual (English and Spanish) to effectively serve diverse member populations. Financial ...
New
WI · On-site
$55 - $75/hr
Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review. * Bilingual (English and Spanish) to effectively serve diverse member populations. Financial ...
New
Clinical Appeals Coordinator
Oregon, WI · On-site
$46 - $84/hr
Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN license. Specialty Therapy Requirement: Master's degree in area of specialty therapy or equivalent ...
New
Clinical Appeals Coordinator
Oregon, WI · On-site
$46 - $84/hr
Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN license. Specialty Therapy Requirement: Master's degree in area of specialty therapy or equivalent ...
New
Clinical Appeals Coordinator
Oregon, WI · On-site
$47 - $84/hr
Managed care or utilization review experience preferred. License/Certification: * LPN, LVN, or RN license. Specialty Therapy Requirement: * Master's degree in area of specialty therapy or equivalent ...
New
Clinical Appeals Coordinator
Oregon, WI · On-site
$47 - $84/hr
Managed care or utilization review experience preferred. License/Certification: * LPN, LVN, or RN license. Specialty Therapy Requirement: * Master's degree in area of specialty therapy or equivalent ...
New
MDS Coordinator
Oshkosh, WI · On-site
$80K - $90K/yr
Position: MDS Coordinator ($10,000 SIGN-ON BONUS) * $10,000 SIGN-ON BONUS paid in 4 quarters ... 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
Position: MDS Coordinator ($10,000 SIGN-ON BONUS) * $10,000 SIGN-ON BONUS paid in 4 quarters ... Run Utilization Review Meetings and ensure PDPM scores and rates are validated * Review and Educate ...
CARE COORDINATOR
Milwaukee, WI · On-site
$50K - $55K/yr
... utilization review or care coordination in a public or private sector. Experience: Minimum 2 years of patient care experience. Behavioral Health, Hospital, Clinic, or school nursing experience is a ...
Quick apply
CARE COORDINATOR
Milwaukee, WI · On-site
$50K - $55K/yr
... utilization review or care coordination in a public or private sector. Experience: Minimum 2 years of patient care experience. Behavioral Health, Hospital, Clinic, or school nursing experience is a ...
Intake Coordinator
$17.50 - $24/hr
The Intake Coordinator is accountable for coordinating the Assessment and Referral activities at ... with the Director, utilization review staff, Granite Hill Hospital business office staff and ...
Intake Coordinator
$17.50 - $24/hr
The Intake Coordinator is accountable for coordinating the Assessment and Referral activities at ... with the Director, utilization review staff, Granite Hill Hospital business office staff and ...
Utilization Review Coordinator information
See Wisconsin salary details
$16.01 - $18.84
7% of jobs
$21.43 is the 25th percentile. Wages below this are outliers.
$18.84 - $21.66
19% of jobs
$21.66 - $24.48
22% of jobs
The median wage is $24.77 / hr.
$24.48 - $27.31
11% of jobs
$27.31 - $30.13
4% of jobs
$30.13 - $32.95
5% of jobs
$34.15 is the 75th percentile. Wages above this are outliers.
$32.95 - $35.78
14% of jobs
$35.78 - $38.60
10% of jobs
$38.60 - $41.42
4% of jobs
$41.42 - $44.25
2% of jobs
$44.25 - $47.07
1% of jobs
$16
$29
$47
How much do utilization review coordinator jobs pay per hour?
As of Sep 3, 2026, the average hourly pay for utilization review coordinator in Wisconsin is $29.89, according to ZipRecruiter salary data. Most workers in this role earn between $21.59 and $34.95 per hour, depending on experience, location, and employer.
What does a utilization review coordinator do?
A Utilization Review Coordinator is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and regulatory requirements. By coordinating between healthcare providers, insurance companies, and patients, Utilization Review Coordinators help optimize resource use and manage healthcare costs while ensuring quality patient care.
What skills and qualifications are needed to be a utilization review coordinator?
To thrive as a Utilization Review Coordinator, you need expertise in healthcare regulations, clinical guidelines, and case management, often supported by an RN license or a background in health administration. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance approval processes are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills ensure compliance, optimize resource use, and support quality care delivery within healthcare organizations.
How does a utilization review coordinator collaborate with healthcare providers and insurance companies?
A Utilization Review Coordinator regularly communicates with both healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. They review medical records and treatment plans, discuss cases with physicians to clarify medical necessity, and submit documentation to insurance payers for approval. This role requires strong interpersonal skills, as coordinators often need to negotiate coverage decisions and resolve discrepancies between clinical teams and insurers. Effective collaboration ensures timely authorizations and helps avoid unnecessary delays in patient care.
What is the difference between Utilization Review Coordinator vs Utilization Review Nurse?
| Aspect | Utilization Review Coordinator | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a healthcare-related certification or associate degree | Registered Nurse (RN) license required |
| Work Environment | Office setting, administrative tasks, coordination | Clinical setting, patient chart review, direct communication with healthcare providers |
| Employer & Industry | Insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare providers |
| Common Search & Comparison | Focuses on administrative review processes | Involves clinical assessment and patient care considerations |
While both roles involve reviewing healthcare utilization, the Utilization Review Coordinator primarily handles administrative and coordination tasks, often without direct patient contact, whereas the Utilization Review Nurse performs clinical assessments as a licensed RN, often in hospital or clinical settings. Understanding these differences helps job seekers identify the right role based on their credentials and career goals.
What are the most commonly searched types of Utilization Review jobs in Wisconsin?
The most popular types of Utilization Review jobs in Wisconsin are:
What are popular job titles related to Utilization Review Coordinator jobs in Wisconsin?
For Utilization Review Coordinator jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Utilization Review Coordinator jobs in Wisconsin look for?
The top searched job categories for Utilization Review Coordinator jobs in Wisconsin are:
- Remote Navihealth Utilization Review
- Prior Authorization Utilization Review
- Weekend Utilization Review
- Temporary Aetna Utilization Review Nurse
- Clinical Review Coordinator
- Flex Schedule Remote Utilization Review
- Utilization Review Coordinator Remote
- Dental Utilization Review
- Remote Aetna Utilization Review
- Rn Intake Coordinator
What cities in Wisconsin are hiring for Utilization Review Coordinator jobs?
Cities in Wisconsin with the most Utilization Review Coordinator job openings:
Full-time
Re-posted 28 days ago
Network Health rating
7.9
Based on 5 frontline employees who took The Breakroom Quiz
187th of 315 rated insurance
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.
Location: 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: 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:
Job Requirements:
Network Health is an Equal Opportunity Employer
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
Location: 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: 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
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
About Network Health
Sourced by ZipRecruiter
Industry
Insurance services
Company size
201 - 500 Employees
Headquarters location
Menasha, WI, US
Year founded
1982