ZipRecruiter

Log In

1

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

Froedtert

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI

$36.38 - $56.39/hr

Assists the case managers with utilization review issues, and provides recommendations for process ... Professional knowledge of nursing theory and practice at a level normally acquired through ...

FROEDTERT HEALTH

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

Assists the case managers with utilization review issues, and provides recommendations for process ... Professional knowledge of nursing theory and practice at a level normally acquired through ...

AHS Vista LLC

Case Manager Full Time and PRN

Waukegan, IL · On-site

$36 - $55/hr

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

AHS Vista LLC

Case Manager Full Time and PRN

Waukegan, IL · On-site

$36 - $55/hr

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

next page

Showing results 1-20

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

Utilization Review Nurse information

See Racine, WI salary details

$20

$39

$64

How much do utilization review nurse jobs pay per hour?

As of Jun 15, 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 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 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 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 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.

How to make $150,000 as a nurse?

To earn $150,000 as a Utilization Review Nurse, gaining extensive experience, obtaining certifications such as the Certified Professional Utilization Review (CPUR), and working in high-demand settings like insurance companies or managed care organizations can help increase earning potential. Advanced skills in medical record review, strong knowledge of healthcare policies, and sometimes working overtime or in leadership roles contribute to higher salaries.

What does a nurse do in a utilization review?

A utilization review nurse evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure that patient care aligns with insurance policies and clinical guidelines, often working with healthcare providers and insurance companies to approve or deny services. This role requires strong clinical knowledge, attention to detail, and familiarity with healthcare regulations and documentation tools.

How to get into utilization review as a nurse?

To become a utilization review nurse, you typically need to be a registered nurse with clinical experience and obtain knowledge of insurance policies and healthcare regulations. Many employers prefer candidates with certifications such as the Certified Professional in Healthcare Quality (CPHQ) or related credentials. Gaining experience in case management or clinical review can improve your chances of entering the field.

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.

Is it hard to be a utilization review nurse?

Being a utilization review nurse can be challenging due to the need for strong clinical knowledge, attention to detail, and the ability to make quick, accurate decisions based on medical records and guidelines. The job often involves working with insurance policies, documentation, and sometimes tight deadlines, but it also offers a structured environment and opportunities for certification and professional development.
More about Utilization Review Nurse jobs
What are popular job titles related to Utilization Review Nurse jobs in Racine, WI? For Utilization Review Nurse jobs in Racine, WI, the most frequently searched job titles are:
What job categories do people searching Utilization Review Nurse jobs in Racine, WI look for? The top searched job categories for Utilization Review Nurse jobs in Racine, WI are:
What cities near Racine, WI are hiring for Utilization Review Nurse jobs? Cities near Racine, WI with the most Utilization Review Nurse job openings:
Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Racine, WI as of June 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $82,465 per year, or $39.6 per hour.
RN UTILIZATION REVIEW, FCH - ENTERPRISE QUALITY CDI/UR/DM

RN UTILIZATION REVIEW, FCH - ENTERPRISE QUALITY CDI/UR/DM

FROEDTERT HEALTH

Menomonee Falls, WI • On-site

$34 - $52.70/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

Job description

Discover. Achieve. Succeed. #BeHere
Location: US:WI:MENOMONEE FALLS at our WOODLAND PRIME 400 facility.
This job is REMOTE.
FTE: 0.500000
Standard Hours: 20.00
Shift: Shift 1
Shift Details:
A week -4 TEN hour Days Thurs through Sunday
Job Summary:
Assumes responsibility for assessing a patient's clinical status on admission and daily to determine the appropriate admission status type and level of care. Refers cases to the physician advisor, PA moonlighter, for a second level review as needed. Facilitates communication with service based multidisciplinary team as it relates to the patient and identified treatment plan. Works in accordance to established policies and procedures to ensure optimal patient outcomes. Has the ability to work with variable service lines and with multiple care teams.
EXPERIENCE DESCRIPTION:
Minimum of 3 years of acute care nursing experience is required; Prior utilization management or case management experience is required. A minimum of 5 years of acute care nursing experience is preferred. Utilization of Interqual, MCG care web QI or Indicia evidence based guidelines is strongly preferred.
EDUCATION DESCRIPTION:
Professional knowledge of nursing theory and practice at a level normally acquired through completion of a program at an accredited School of Nursing is required. Bachelor's Degree in Nursing is preferred.
SPECIAL SKILLS DESCRIPTION:
Knowledge of Medicare inpatient only surgical list, Medicare guidelines for admission, working DRG, and some familiarity with hospital coding is preferred.
LICENSURE DESCRIPTION:
Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). MCG certification is required within 18 months of hire. Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred.
Compensation, Benefits & Perks at Froedtert Health
Pay is expected to be between: (expressed as hourly) $34.00- $52.70. Final compensation is based on experience and will be discussed with you by the recruiter during the interview process.
Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:
  • Paid time off
  • Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
  • Academic Partnership with the Medical College of Wisconsin
  • Referral bonuses
  • Retirement plan - 403b
  • Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
  • Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.
Froedtert logo

About Froedtert

Sourced by ZipRecruiter

Froedtert is a world-class healthcare organization based in Milwaukee, WI, United States. The company operates within the healthcare and wellness industry, providing a broad spectrum of medical services to the residents of southeastern Wisconsin and beyond. Froedtert was founded in 1980 and is an academic health network, which ripples an integrated affiliation with the Medical College of Wisconsin. The company prides itself on its cutting-edge treatments, sophisticated technology, and groundbreaking research. Froedtert’s mission is to advance health in the communities they serve, with a profound commitment towards patient care, education, research and community outreach.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Milwaukee, WI, US

Year founded

1980

View All Froedtert Jobs

Apply