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

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. · ...

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 ...

US Navy

Registered Nurse

Green Bay, WI · On-site

... 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 · On-site

... 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 · On-site

... 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

Appleton, WI · On-site

... 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 · On-site

... 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 · On-site

... 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 · On-site

... 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 · On-site

... 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 · On-site

... 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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Showing results 21-40

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 Sep 7, 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.

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.

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.

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 get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

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 August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,812 per year, or $41.3 per hour.

Registered Nurse

Carepros, LLC

Appleton, WI • On-site

Full-time

Re-posted 4 days ago

Job description

POSITION PURPOSE: The Registered Nurse (RN) is a licensed medical professional who performs duties related to supervising the Client's Personal Care Worker (PCW). These duties include but are not limited to supervision, training, evaluating, development and implementation of a plan of care (POC) for CAREPROS’S Clients. These duties are performed under the supervision of the Executive Director or CEO.

MAJOR RESPONSIBILIES AND JOB FUNCTIONS:

1. Assess and evaluate the need for services and make referrals to other services as appropriate.

2. Secure written orders from the Client's physician. These orders are to be renewed once every three months unless the physician specifies that orders covering a period up to one year are appropriate or when the Client's needs change, whichever occurs first.

3. Develop a plan of care for the Client, considering the Client's preferences for service arrangements and choice of personal care workers, interpret the plan to the PCW, include a copy of the plan in the Client's health record, and review the plan at least every 60 days and update it as necessary.

4. Ensure services are performed according to a written plan of care. 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.

· Evaluation of the recipient's needs and preferences; and

· Assessment of the recipient's social and physical environment, including family involvement, living conditions, the recipient's level of functioning and any pertinent cultural factors such as language.

5. Review the plan of care, evaluate the Client's condition, and supervise the PCW at least every sixty (60) days. The review shall include a visit to the recipient's home, review of the PCW's daily written record and discussion with the physician of any necessary changes in the plan of care.

6. Develop appropriate time and service reporting mechanisms for personal care workers and instruct the workers on their use.

7. Give the PCWs written instructions about the services to be performed and arrange for an appropriate person to demonstrate to the personal care worker how to perform the services.

8. RN Travel to Client's home to perform the above duties and report back to the supervisor the status of the Client's care with recommendations for improvement when necessary.

9. Performs other tasks as designated by their Executive Director, or CEO.