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

CenterWell

Registered Nurse Clinical Manager

Racine, WI · On-site

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 ...

Froedtert Health

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 ...

Froedtert South, Inc.

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 ...

Team Wellness Corporation

CARE COORDINATOR

Milwaukee, WI · On-site

$50K - $55K/yr

... Nurse, or closely related field. 1 year experience in social services, hospital work, clinic work, utilization review or care coordination in a public or private sector. Experience: Minimum 2 years ...

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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 Aug 18, 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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For Utilization Review Nurse jobs in Racine, WI, the most frequently searched job titles are:

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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 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.

Registered Nurse Clinical Manager

CenterWell Primary Care

West Allis, WI • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago

CenterWell rating

9.0

Company rating: 9.0 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

Become a part of our caring community
$10,000 SIGN ON BONUS!
Work Schedule: Full-time/40 Hours
Position Type: On-site
Branch Location: West Allis, WI
This is NOT a remote or work-from-home position. You will sit on-site at our West Allis, WI branch location.
As a Clinical Manager at CenterWell Home Health, reporting to the Branch Director, you will lead and support a team of dedicated clinicians who deliver compassionate, highquality care in the home setting. By guiding clinical practice, coordinating patient services, and ensuring excellence in every step of the care journey, you'll empower patients to achieve their highest level of independence while helping your team thrive in their roles.

As a Registered Nurse Clinical Manager, you will:

  • Oversee clinical operations for the location, including patient care delivery, staff management, documentation quality, and regulatory compliance, working onsite in-office.
  • Review referrals, determine admission appropriateness, assign clinicians, and ensure Plans of Care meet patient needs and agency standards.
  • Guide, support, and educate clinicians; help goalset, care planning, and clinical decisionmaking; and remain available during operating hours for clinical support.
  • Ensure clinical documentation, audits, and billing meet Medicare, payer, and company standards; monitor case management quality and outcomes.
  • Participate in hiring, training, performance evaluation, coaching, and corrective action for clinical staff.
  • Conduct ongoing staff education based on documentation review, utilization review findings, and performance improvement data.
  • Coordinate communication among physicians, team members, and caregivers to support care coordination, discharge planning, and outcome achievement.
  • Participate in quality improvement, data tracking, budgeting activities, marketing initiatives, and community relationship development.
  • Provide direct patient care on a limited basis in exceptional or unplanned circumstances and act as Branch Director in their absence.
  • Perform additional tasks to support clinical operations and organizational goals.

Use your skills to make an impact

Required Experience/Skills:

  • Graduate of an accredited School of Nursing.
  • Current state license as a Registered Nurse.
  • Proof of current CPR.
  • Valid driver's license, auto insurance and reliable transportation.
  • Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment.
  • Home health experience is required.
  • Management and people leadership experience, required.
  • OASIS experience, required.
  • Homecare Homebase (HCHB) experience, preferred.
  • CMS PDGM billing knowledge or experience, preferred.

Additional Information

  • Normal Hours of Operation: M-F / 8a-5p (CT)
  • On-Call: Required
  • Branch Size: 156 Census (4.5 STAR rating)
  • Annual Bonus: Eligible for the annual incentive bonus which has pay-outs both quarterly and annually.

Additional Information

TB Statement:

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Driving Statement:

This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.


$77,200 - $106,200 per year


This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer atCenterWell.com.


Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

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