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Utilization Review Nurse Jobs in Racine, WI (NOW HIRING)

Froedtert

RN, Denials Management

Menomonee Falls, WI · On-site

$36.38 - $56.39/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Assists the case managers with utilization review issues, and provides recommendations for process ... A minimum of 5 years of acute care nursing experience or 5 years nursing with relevant denials ...

GQR Healthcare

Travel RN Case Manager

Racine, WI · On-site

$1.8K - $1.9K/wk

  • Medical

  • Dental

  • Vision

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Racine, Wisconsin Start Date: September 13, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

New

AHS Vista LLC

Case Manager Full Time and PRN

Waukegan, IL · On-site

$36 - $55/hr

  • Medical

Oversee the discharge planning process, working closely with physicians, nurses, and other healthcare professionals to ensure smooth transitions.Perform utilization review to assess medical necessity ...

AHS Vista LLC

Case Manager Full Time and PRN

Waukegan, IL · On-site

$36 - $55/hr

  • Medical

Oversee the discharge planning process , working closely with physicians, nurses, and other healthcare professionals to ensure smooth transitions. * Perform utilization review to assess medical ...

American Traveler

Travel RN Case Manager

Racine, WI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Travel RN - Case Management/Utilization Review - Case Management About American Traveler With over 25 years of experience, American Traveler has established a reputation for outstanding customer ...

New

Centerwell

Registered Nurse Clinical Manager

Racine, WI · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

As a Registered Nurse Clinical Manager , you will: * Oversee clinical operations for the location ... Conduct ongoing staff education based on documentation review, utilization review findings, and ...

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All JobsUtilization Review Nurse JobsUtilization Review Nurse Jobs in Racine, WI

Utilization Review Nurse information

See Racine, WI salary details

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$39

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How much do utilization review nurse jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for utilization review nurse in Racine, WI is $39.65, according to ZipRecruiter salary data. Most workers in this role earn between $31.35 and $45.53 per hour, depending on experience, location, and employer.

What does a utilization review nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What does a utilization review nurse do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

What are the key skills and qualifications needed to thrive as a utilization review nurse, and why are they important?

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What is the difference between Utilization Review Nurse vs Case Manager?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

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Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Racine, WI as of August 2026, with employment types broken down into 94% Full Time, and 6% Contract. Highlights an 65% In-person, 11% Hybrid, and 24% Remote job distribution, with an average salary of $82,465 per year, or $39.6 per hour.

Administrative Assistant for Utilization Review

V COVINGTON LLC

Waukegan, IL • On-site

$19 - $26/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 3 days ago

Job description

JOIN OUR TEAM AS A Administrative Assistant - Utilization Review - Part Time
Your Work MattersHow will you make a difference?
The Administrative Assistant is responsible for providing administrative support for the Utilization Management department, including performing clerical duties, attending departmental meetings, coordinating staff activities, staff educational files and providing support for the Director of Clinical Programming.
Schedule: Monday - Friday flexiable hours ( 8am-1pm) or Monday - Thursday (8am- 2pm)
Your Experience Matters What we're looking for:
  • Education: Associate Degree in Business Administration or related field preferred; or an equivalent combination of education and experience.
  • Experience: At least one (1) year experience as an Administrative Assistant in a health care setting preferred in a health care setting; or combination of education, training and experience.
  • Additional Requirements: Must be able to type at least 65 w.p.m.; knowledge of Word and Excel software programs; and experience as a mental health technician desired. Ability to work overtime and flexible hours, as requested.

PRIMARY RESPONSIBILITIES
Primary duties may include, but are not limited:
  • Completes frontline and clerical support to the Utilization Review team in processing daily, weekly, and monthly reports
  • Managing incoming calls or incoming emails from insurance companies and route them appropriately.
  • Follow-up on appeal submissions to determine status.
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure clinical requests and questions are handled appropriately and in a timely manner.
  • Verify patient insurance eligibility as needed
  • Complete follow-up calls for Utilization Review Coordinators to maintain compliance on authorization timeframes.
  • Provide support for documentation uploads of authorizations.
  • Troubleshoot for missing documentation as requested.
  • Responds to tasks and written request from coordinators, providers and internal departments.

  • Open and distribute mail for the department.
  • Order supplies for the department, maintain a cost-effective and efficient office.
  • Consistently prioritize workloads to ensure daily work is completed.
  • Adhere to facility, department and Corporate Personnel Policies and Procedures.

Your Care MattersWhat we provide for our team:
  • 401(k) + matching
  • Health insurance
  • 100% company-paid life insurance coverage up to 2x your annual salary
  • Vision insurance
  • Dental insurance
  • 100% company-paid long term disability insurance
  • Paid time off
  • Cafeteria on site + discounted meals
  • Employee engagement events
  • Employee assistance program
  • Employee recognition program
  • Free parking

What sets us apart:
  • Career & training development opportunities
  • Dynamic and inclusive work environment
  • Engaged management team dedicated to your success
  • A guiding mission and set of values that serve as both our north star and yours, anchoring our collective purpose and aspirations

Disclaimer: Benefits are subject to change at the discretion of Lake Behavioral Hospital.
Compensation:
This is a Part-Time role and the expected compensation range for this role is $19.00 -$26.00 hourly. We're eager to engage with all qualified candidates, and consideration will be provided to experience and skill level. Join us as our Administrative Assistant for Utilization Review.
Get to know us Outstanding Care, Compassionate People, Unparalleled Service
Discover a fulfilling career at Lake Behavioral Hospital (LBH)!
We are a 161-bed acute care facility located in Waukegan, IL and has been providing mental health treatment to the community and the state of Illinois since 2018. We are dedicated to offering services to meet the ever-changing emotion and behavioral healthcare needs of adolescents, adults, and their families. We offer specialized inpatient programs and outpatient services proven to decrease symptoms of mental illness and we are committed to help people live healthier lives. Our compassionate and experienced team of psychiatrists, licensed therapists, nurses and support staff are here to create an atmosphere of health, hope, and healing.
Join us in providing exceptional care and contributing to the well-being of individuals and families in need, and be a part of the transformative healthcare experience at Hospital for Behavioral Medicine.
  • To learn more about LBH, visit us at: https://www.lakebehavioralhospital.com/

TOGETHER WE CAN MAKE POSITIVE I.M.P.A.C.T.S.
Individuals Maintaining Positive Attitude and Commitment To Service
At Lake Behavioral Hospital, we value a diverse, inclusive workforce and provide equal employment opportunities for all applicants and employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, gender identity or expression, age, marital status, veteran status, disability status, pregnancy, parental status, genetic information, political affiliation, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.

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