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

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 ...

Pharmacist

Pleasant Prairie, WI · On-site

$51.50/hr

Provides medication order verification and clinical services to the nursing staff, physicians, and ... and drug utilization review. * Demonstrates the ability to access, enter and adjust patient ...

Pharmacist

Pleasant Prairie, WI · On-site

$51.50/hr

Provides medication order verification and clinical services to the nursing staff, physicians, and ... and drug utilization review. * Demonstrates the ability to access, enter and adjust patient ...

Showing results 21-40

Utilization Review Nurse information

See Racine, WI salary details

$20

$39

$64

How much do utilization review nurse jobs pay per hour?

As of Sep 7, 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.

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:

Infographic showing various Utilization Review Nurse job openings in Racine, WI as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 17% Part Time, 2% Contract, and 4% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $82,465 per year, or $39.6 per hour.

Director of Nursing (DON)

Milwaukee Nursing and Rehab

Milwaukee, WI

Full-time

Medical, Retirement, PTO

Re-posted 16 days ago


Job description

UNDER NEW OWNERSHIP

Benefits of (Director of Nursing) DON position:

  • Low Cost Health Insurance
  • Vacation and Sick Time
  • Great Work Environment
  • 401k Matched at 10%
  • Flexible Hours (8-hour shifts)
  • Paid Holidays
  • Tuition Assitance
  • Instant Pay (*TapCheck)
  • Robust Employee Appreciation Program
  • Job location: Milwaukee

Milwaukee Nursing and Rehab makes it top priority to care for seniors with the respect, compassion, and dignity they deserve. We understand that caring is what makes a community and without a sense of caring, there can be no sense of community. It is what sets us apart from any other Skilled Nursing Facility.

At Milwaukee Nursing and Rehab, our nursing staff are overly courteous, respectful and always maintain a high level of professionalism. Our primary goal is to get you back in a condition to be independent once again while maintaining a friendly environment and providing nutritionally enhanced meals.

We are looking for a Director of Nursing (DON) to care for our patients and facilitate their speedy recovery. You will also be responsible for educating them and their families on prevention and healthy habits. The ideal candidate will be a responsible and well-trained professional able to give the best nursing care with little supervision. You will be able to follow health and safety guidelines faithfully and consistently. The goal is to-promote patient’s being-by providing high quality nursing care.

 

Responsibilities: Director of Nursing (DON)

  • Ensures that nursing interventions meet the personal, physical and cognitive needs of each patient/resident as well as maximize his/her self care capacities, identity, independence, choice and opportunity for social interaction.
  • Monitors the outcomes of nursing service activity by evaluating the performance of nursing staff, ensuring compliance with all facility and regulatory agency standards, policies and procedures, coordinating facility committees and monitoring the effective and efficient use of budgeted resources (personnel, supplies, equipment).
  • Assumes full responsibility for the operation and management of the facility in the temporary absence of the Facility Administrator or as directed by the Administrator.
  • Develops short and long-range plans for the nursing department that are compatible with those of the facility.
  • Assists in recruiting and selects nursing service employees appropriate to facility need and budgetary guidelines.
  • Works in establishing and facilitating effective employer/employee relations.
  • Maintains adequate staffing ratios and levels of preparation to meet the needs of patients/residents.
  • Participates in the selection of patients/residents to be admitted by evaluating the level and amount of care required by prospective patients/residents in relation to existing nursing capabilities.
  • Actively maintains cohesive public and professional relationships with patients/residents, families, physicians and the community.
  • Incorporates nursing philosophy, standards and objectives into the evaluation process for staff and nursing services and ensures that the philosophy, objectives and standards of the nursing department are an integral part of the orientation and education of nursing service personnel.
  • Coordinates requirements and cooperates with all other departments in providing a favorable physical, social and emotional environment for all patients/residents.
  • Serves on Quality Improvement and Safety Committees that include Patient/Resident Standards of Care, Pharmaceutical Services, Infection Control, Safety and Utilization Review/PPS.
  • Meets with committee members to evaluate activities within the facility and to identify opportunities for continuous improvement in nursing operations.

 

Requirements: Director of Nursing (DON)

  • A minimum of 2-3 years’ management experience
  • A team player with excellent communication and interpersonal skills
  • Outstanding organizational and multi-tasking skills
  • Valid nursing license in the state of Wisconsin

 

Apply now to join our team as a DON and help make a real difference! Walk-ins welcome.