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

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 ...

Network Health

RN Care Manager

Menasha, WI · Remote

Review results from medical or behavioral tests and procedures and updates care plan to reflect ... Previous experience in case management, utilization management, insurance, or managed care ...

Network Health, Inc

RN Care Manager

Menasha, WI · Remote

Review results from medical or behavioral tests and procedures and updates care plan to reflect ... Previous experience in case management, utilization management, insurance, or managed care ...

Wisconsin

Registered Nurse

Oshkosh, WI

Registered Nurse Job Category: Academic Staff Employment Type: Regular Job Profile: Registered ... Reviews and updates nursing protocols, standing orders, policies and procedures on an annual basis ...

Universities of Wisconsin

Registered Nurse

Oshkosh, WI · On-site

Registered Nurse Job Category: Academic Staff Employment Type: Regular Job Profile: Registered ... Reviews and updates nursing protocols, standing orders, policies and procedures on an annual basis ...

US Navy

Registered Nurse

Green Bay, WI

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Greenville, WI

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Kimberly, WI

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Oshkosh, WI

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Bellevue, WI

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Reedsville, WI

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Manawa, WI

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

US Navy

Registered Nurse

Fremont, WI

... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Appleton, WI

Utilization Review Rn information

See Appleton, WI salary details

$20

$41

$67

How much do utilization review rn jobs pay per hour?

As of Jul 6, 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 to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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.

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.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, 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.

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 Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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 July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $85,812 per year, or $41.3 per hour.
Registered Nurse (RN) - PM Shift

Registered Nurse (RN) - PM Shift

St. Paul Elder Services

Kaukauna, WI • On-site

$37.50 - $44.50/hr

Part-time

Posted 3 days ago

St. Paul Elder Services rating

8.6

Company rating: 8.6 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

Registered Nurse (RN) – PM Shift

St. Paul Elder Services
Kaukauna, WI
Full-time, Part-time
PM Shift
Competitive Pay + Shift Differential

PM Shift Premium: +$2.00 per hour

Sign-On Bonus

  • $1,000 after 3 months of employment
  • $1,000 after 8 months of employment
  • $1,500 after 1 year of employment

(Available for positions scheduled 56 hours biweekly or more.)

Position Summary

St. Paul Elder Services is seeking compassionate and dedicated Registered Nurses (RNs) to join our evening nursing team. As an RN, you will provide direct resident care while supervising and supporting the nursing staff to ensure high-quality, resident-centered care. This role is responsible for clinical assessments, medication administration, care planning, documentation, and coordinating care with physicians, residents, families, and the interdisciplinary team.

This position offers the opportunity to work in either our Long-Term Care or Post-Acute Rehabilitation neighborhoods while making a meaningful impact in the lives of the seniors we serve.

Key Responsibilities
  • Provide high-quality, compassionate nursing care to residents.
  • Assess resident conditions and develop, implement, and revise individualized care plans.
  • Utilize the nursing process, including assessment, planning, intervention, and evaluation, to deliver quality care.
  • Administer medications and treatments in accordance with physician orders and nursing standards of practice.
  • Monitor resident conditions and communicate changes through accurate documentation and verbal reports.
  • Review medical records, physician orders, and nursing care plans to ensure continuity of care.
  • Participate in interdisciplinary care conferences and contribute to resident care planning.
  • Supervise and provide clinical guidance to LPNs, Graduate Nurses, Nurse Techs, Medication Technicians, and Certified Nursing Assistants (CNAs).
  • Assist physicians during treatments and physician progress visits.
  • Conduct resident assessments for changes in condition and provide clinical support to other nursing units as needed.
  • Mentor and support Graduate Nurses and Nurse Techs while ensuring practice within their scope.
  • Assist with staff scheduling and work assignments.
  • Complete staff competencies and provide ongoing education and coaching as appropriate.
  • Monitor the safe use of medical equipment and supplies.
  • Counsel residents and family members regarding care and treatment as appropriate.
  • Communicate resident concerns, significant changes, and facility emergencies to nursing leadership.
  • Collaborate with all departments to promote exceptional resident care and positive outcomes.
Required Qualifications
  • Current Wisconsin Registered Nurse (RN) license.
  • Strong clinical assessment and critical thinking skills.
  • Excellent communication, organizational, and documentation abilities.
  • Ability to supervise and lead nursing staff with professionalism and compassion.
  • Ability to work collaboratively within an interdisciplinary healthcare team.
  • Commitment to providing exceptional resident-centered care.
Preferred Qualifications
  • Previous experience in long-term care, post-acute rehabilitation, skilled nursing, or senior living.
  • Prior leadership or charge nurse experience.
  • Experience with resident assessments, care planning, and medication administration.
  • Experience using electronic medical records (EMR).
What We Offer
  • Competitive pay based on experience.
  • $2.00/hour PM shift differential
  • Generous sign-on bonus opportunities.
  • Supportive leadership and collaborative nursing team.
  • Ongoing education and professional development.
  • Opportunities for career growth and advancement.
  • Meaningful work in a resident-focused environment dedicated to quality care.
Work ScheduleCurrent PM Shift Openings

Long-Term Care

  • 40 hours biweekly
  • 2:15 PM – 10:45 PM
  • Every other weekend and every other holiday required

Post-Acute Rehabilitation

  • 64 hours biweekly
  • 2:15 PM – 10:45 PM
  • Every other weekend and every other holiday required
Work Location

In person
Kaukauna, Wisconsin

What St. Paul Elder Services employees say

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