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Utilization Review Rn Jobs in Appleton, WI (NOW HIRING)

Interim HealthCare

Registered Nurse (RN)

Menasha, WI

$35 - $40/hr

Review, interpret, transcribe and carry out physician orders for patients * Administer medication, operate medical equipment and maintain a safe environment A few must-haves for Registered Nurses:

Eden Senior Care

MDS Coordinator

Oshkosh, WI · On-site

$80K - $90K/yr

Run Utilization Review Meetings and ensure PDPM scores and rates are validated * Review and Educate ... Must hold an active LPN or RN license in the state of Wisconsin. * Strong knowledge of the MDS ...

Carepros, LLC

Registered Nurse

Appleton, WI · On-site

The plan shall be based on the RN's visit to the Client's home and shall include: • Review and interpretation of the physician's orders. • Frequency and anticipated duration of service. • ...

Carepros, LLC

Registered Nurse

Appleton, WI

The plan shall be based on the RN's visit to the Client's home and shall include: · Review and interpretation of the physician's orders. · Frequency and anticipated duration of service. · ...

Carepros, LLC

Registered Nurse

Appleton, WI · On-site

$40 - $45/hr

The plan shall be based on the RN's visit to the Client's home and shall include: · Review and interpretation of the physician's orders. · Frequency and anticipated duration of service. · ...

Carepros, LLC

Registered Nurse

Appleton, WI

The plan shall be based on the RN's visit to the Client's home and shall include: • Review and interpretation of the physician's orders. • Frequency and anticipated duration of service. • ...

Carepros, LLC

Registered Nurse

Appleton, WI

The plan shall be based on the RN's visit to the Client's home and shall include: · Review and interpretation of the physician's orders. · Frequency and anticipated duration of service. · ...

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Utilization Review Rn information

See Appleton, WI salary details

$20

$41

$67

How much do utilization review rn jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for utilization review rn in Appleton, WI is $41.26, according to ZipRecruiter salary data. Most workers in this role earn between $32.60 and $47.36 per hour, depending on experience, location, and employer.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

What are the key skills and qualifications needed to thrive as a Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Appleton, WI? The most popular types of Utilization Review Rn jobs in Appleton, WI are:
What are popular job titles related to Utilization Review Rn jobs in Appleton, WI? For Utilization Review Rn jobs in Appleton, WI, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Appleton, WI look for? The top searched job categories for Utilization Review Rn jobs in Appleton, WI are:
What cities near Appleton, WI are hiring for Utilization Review Rn jobs? Cities near Appleton, WI with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Appleton, WI as of June 2026, with employment types broken down into 87% Full Time, 11% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $85,812 per year, or $41.3 per hour.
Registered Nurse Utilization Review

Registered Nurse Utilization Review

Ascension

Appleton, WI • On-site

Full-time

Medical, PTO

This job post has expired today. Applications are no longer accepted.

Ascension Healthcare rating

7.0

Company rating: 7.0 out of 10

Based on 1,002 frontline employees who took The Breakroom Quiz

404th of 870 rated healthcare providers

Job description

Your future role at a glance

Location: Appleton, WI

Facility: Ascension St. Elizabeth

Department/Specialty: Behavioral Health

Schedule: Full-time 0.9 FTE days | 8:00 AM-4:30 PM Monday-Friday | 1 week will be 5 days and the opposite week will be 4 days

How you'll make an impact in this role

Provide health care services regarding admissions, case management, discharge planning and utilization review.

  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
What minimum qualifications you'll need

Licensure / Certification / Registration:

  • Registered Nurse credentialed from the Wisconsin Board of Nursing obtained prior to hire date or job transfer date. Licensure from the Wisconsin Board of Nursing OR current home state license if considered multi-state/Compact State required.

Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
What additional requirements you'll need
  • Utilization Review and insurance experience preferred.
  • Behavioral health experience preferred.
Life at Ascension: Where purpose meets opportunity

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.

Equal employment opportunity employer

Equal employment opportunity employer

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

Fraud prevention notice

Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

E-Verify statement

Employer does not participate in E-Verify and therefore cannot employ STEM OPT candidates.

Benefits

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.

Employment Type: FULL_TIME

What Ascension Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Ascension

Sourced by ZipRecruiter

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Industry

Health care and social assistance and outpatient health care

Company size

10,000+ Employees

Headquarters location

St. Louis, MO, US

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