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

Rogers Behavioral Health

Registered Nurse

Appleton, WI · On-site

The registered nurse seeks consultation with other members of the health team as the patient ... Review the treatment plan as goals are achieved, changed, or updated. On an ongoing basis, identify ...

Network Health WI

RN Care Manager

Menasha, WI · On-site +1

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 ...

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 ...

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 ...

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 ...

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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 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

Registered Nurse

Rogers Behavioral Health

Appleton, WI • On-site

Full-time

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

Rogers Behavioral Health rating

6.0

Company rating: 6.0 out of 10

Based on 49 frontline employees who took The Breakroom Quiz

729th of 870 rated healthcare providers

Job description

New Employee Retention Bonus
*$2,500.00 retention bonus available!
(New Employee is defined as someone who has not been employed with Rogers for more than six months)
Schedule:
Full - time - 40 hours/week
No weekends / No holidays / No on-call required
4 - 10 hour shifts (7:30a - 6 pm OR 8am - 6:30pm)
The registered nurse (RN, RN II, RN III) performs professional nursing activities in the care of patients so they may achieve or regain, and then maintain, maximum physical, emotional or social functions. Role functions are governed by the Nurse Practice Act, the Administrative Code (in the state of employment), as well as the professional standards for nursing practice, and the corresponding policies and procedures of Rogers Memorial Hospital (Rogers). The registered nurse seeks consultation with other members of the health team as the patient's condition and treatment goals warrant. He/She, in conjunction with the Patient Accounts department, provides patient information to ensure compliance with federal and state statutes.
Job Duties & Responsibilities:
  • Complete initial assessments and documents as required.

Collect, record, and analyze, within prescribed timeframe, pertinent data for admission
assessment according to Hospital policy, including:
  • Patient strengths and limitations that can be addressed in reaching health goals.
  • Cultural, spiritual, and ethnic factors that may impact on patient's course of treatment.
  • Patient needs that are to be addressed at discharge.
  • Medical/physical status.
  • History of medication compliance, reactions, and current schedule; and
  • Age-specific data regarding the patient's individual needs.

Involve patient's support systems (family, friends) in assessment and documentation
  • Observe and document the patient's interaction with family and friends as it is pertinent to the patient's treatment.
  • Obtain assessment data from support systems, when appropriate, regarding the patient's history and individual needs.

Act as an advocate for patients
  • Explain patient's rights so they can understand and obtain appropriate signatures.
  • Provide the patient with information and obtain their signature on necessary consents.
  • Act as a patient advocate, use knowledge of patient rights and responsibilities, and protect patient's privacy and confidentiality.
  • Assist in patient orientation process.
  • Know and employ Hospital policies and procedures regarding unit safety, the necessity of gown/contraband search on admission, and carry out the process in a respectful manner.
  • Remain sensitive to individual patient/family stressors upon admission while providing pertinent unit information.

Initiate and update treatment plan and documentation as required
  • Participate in planning and modifying the patient's plan of care.
  • Evaluate data obtained by others by reviewing patient's treatment plan and multi-disciplinary assessment for assigned patients.
  • Participate in care conferences (staffings) and represent the nursing care component of the treatment plan to others at the staffing.
  • Develop and interpret plan of care with the patient/family, updating it as indicated.
  • Write clear, concise, and obtainable treatment goals on the treatment plan for each problem.
  • Review the treatment plan as goals are achieved, changed, or updated.

On an ongoing basis, identify, interpret, and document information collected in nursing
interview, observation, physical assessment and diagnostic data, and confer with other
health care professionals, as appropriate
  • Review current lab data and follow-up with doctor.
  • Evaluate potential for falls and initiate fall precautions, as indicated.
  • Identify potential for self-abuse, suicidality and/or assaultive behavior.
  • Develop age-appropriate interventions for the patient's plan of care.
  • Assess changes in patient status and document interventions accordingly.

Implement patient care
  • Demonstrate safe and correct medication administration by:
  • Accuracy in medication administration: right patient, right medication, right dose, right time, and right route.
  • Maintaining current knowledge of the medication's purpose and effects for each patient, as demonstrated by correct documentation of medication, as well as observations about responses to medication.
  • Accurately transcribing and implementing physician medication orders.
  • Maintaining a continual awareness of monitoring the expected and unexpected medication efforts including adverse drug reactions, drug/drug or drug/food interactions, or other unexpected consequences of the medication.
  • Regularly conducting and documenting patient education about medications.
  • Maintaining current knowledge about new pharmacologic products, including new medications or medications with new uses/therapeutic action.

Identify potential patient care problems, abrupt changes, or impending instability in the
patient's condition, and exercise leadership to intervene appropriately and prevent
adverse patient outcomes
  • Use appropriate de-escalation techniques: quiet room; locked seclusion; restraints.
  • Re-evaluate safety level.
  • Identify alcohol withdrawal syndrome.
  • Identify extra pyramidal side-effects/neuroleptic malignant syndrome signs.
  • Identify significant cardiac and/or respiratory symptoms requiring immediate medical intervention.

Identify health education needs of the patient/family that will be addressed before
discharge
  • Implement age-appropriate teaching interventions to meet these educational needs.
  • Document in the patient record and treatment plan.
  • Organize patient care activities and interventions according to patient priorities and preferences, needs of the unit, and time constraints.
  • Implement patient care based on established care plans, Hospital policies and procedures, and unit standards of care, incorporating the patient's age-specific and cultural needs, as appropriate.
  • As requested, and contingent on qualified medical professional (QMP) designation, assure that all admissions, transfers, and other related patient care activities are delivered in accordance with Emergency Medical Treatment and Labor Act (EMTALA) and associated regulatory requirements.
  • Adhere to the Nursing department and Hospital's standards of nursing practice and standards of patient care.
  • Protect patients, visitors, and staff from environmental hazards by adhering to safety and infection control standards.
  • Participate in continuing education and in-service programs to increase clinical competence and to meet professional needs and goals.
  • Report information obtained from continuing education programs to unit staff.
  • Attend 100% of required in-services, as scheduled.
  • Participate in the Performance Improvement program on an ongoing basis.

Assist in the development and implementation of unit standards of care, such as:
  • Safety level of patient
  • Unit safety/hazardous items
  • Kardex

Standard care plans
  • Identify problems with unit systems, communication patterns, and unit resources that impact on patient care and suggest possible solutions to Clinical Services manager.
  • Identify unit educational equipment and supply needs.
  • Serve on one unit-based committee or participate in unit-based projects on an ongoing basis.
  • Participate as a project leader.

Carry out leadership function in patient care, staff operations, and department
organization
  • Contribute to Nursing and Hospital functions through active participation on committees and attendance at designated meetings.
  • Take initiative in evaluating and upgrading unit standards of care.

Assume charge nurse role:
  • Coordinate unit activities
  • Take a leadership role in crisis situations.
  • Facilitate the admission process.
  • Communicate pertinent information regarding unit status and projected needs.
  • Manage the therapeutic milieu and use sound clinical judgment and decision-making skills.
  • Plan patient care assignments that facilitate continuity of care within the unit guidelines and are based on patient needs, unit activity, and nursing staff qualifications.
  • Ensure the unit is kept in an orderly fashion.
  • Serve as a role model for peers and others in effective use of communication, teaching, and leadership skills.
  • Supervise and delegate tasks to LPN/psychiatric technician, taking into account their educational preparation and demonstrated abilities.
  • Provide complete acuity monitors to the Patient Accounts department, to assist in accurate billing.
  • Maintain a primary caseload, according to unit standards, and provide direction for patient care.

Participate in projects, tasks and continuing education opportunities to improve
professional skills and unit/department systems
  • Develop goals and objectives for professional growth and discuss ways to achieve them with Clinical Services manager.
  • Take initiative to develop professional skills through continuing education.
  • Discuss, on a regular basis, progress toward work improvement goals with Clinical Services manager.
  • Seek out projects and/or extra tasks to complete, based upon the needs of the unit or the immediate shift.

Promote department goals and the mission of the hospital
  • Communicate goals to fellow staff members.
  • Demonstrate measurable goal achievement.
  • Maintain department policies and procedures.
  • Include requirements and guidelines from external agencies (i.e., Joint Commission, state).
  • Maintain and/or communicate to appropriate party function backlog at a set time.
  • Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed.
  • Demonstrate acceptance and training of student interns in the department, as directed.

Demonstrate understanding of Joint Commission and other regulatory agency
Compliance regulations
  • Involve self in the learning and application of standards relevant to the Nursing department.
  • Participate in in-services/seminars and other meetings to increase involvement and awareness of regulations.
  • Involve self in the education of other disciplines regarding Nursing department regulations.

Participate in Hospital committees, performance improvement team meetings and team
projects, as directed
  • Demonstrate punctuality and preparedness.
  • Demonstrate effective communication and organizational skills.
  • Contribute in a positive, solution-focused manner.

Participate in the Performance Improvement program
  • Gain understanding of the performance improvement process.
  • Apply the PI model to your department's activities.
  • Participate and/or create PI teams that lead to improvement in other Hospital areas.
  • Educate and involve self in the Hospital and Nursing department's performance improvement plans.

Conduct self in a professional manner
  • Demonstrate organizational skills that promote timely response to all inquiries and to task completion.
  • Communicate with all individuals in a positive and professional manner.
  • Attempt to resolve individual issues with peers in a positive, calm manner, with a focus on solution.
  • Communicate concerns and provide solutions for same.
  • Attend internal and external seminars to promote professional growth.
  • Demonstrate a positive and professional attitude toward parties outside the Hospital (patient families, visitors, vendors, etc.).
  • Comply with the Hospital's policies and procedures, including Human Resources, Infection Control, and Employee Health policies and programs.
  • Use courteous, cooperative, and respectful behavior when working with patients, families, physicians, visitors, and Hospital employees.
  • Demonstrate a working knowledge of Hospital/department policies and procedures.
  • Demonstrate consistent acceptance of professional accountability for own practice shown by follow-through on patient and organizational concerns.
  • Support changes in staffing/scheduling when unit and Hospital patient care needs require.
  • Accept reassignment in a positive manner.
  • Demonstrate willingness to adjust work schedule, when able, to meet patient's needs.
  • Recognize need for support, seek appropriate assistance when needed, and offer assistance to peers.
  • Project a professional image by wearing appropriate, professional attire.

Education/Training Requirements:
  • Bachelor's degree in nursing (BSN) preferred. Registered nurse licensed by State Board of Nursing in the state of employment. License must be in good standing with the State Board of Nursing in the state of employment.
  • American Health Association Healthcare Provider CPR certification or is required within thirty (30) days of date-of-hire. Bi-annual re-certification is required.
  • Formal training in management of the aggressive patient is required within sixty (60) days of date-of-hire. Annual re-certification is required.
  • Previous psychiatric experience with children, adolescents and adults is preferred.
  • At the Hospital's discretion, may be required to hold a qualified medical professional (QMP) designation. Must be deemed competent to serve as a QMP, as outlined in the Medical Staff bylaws of Rogers Memorial Hospital. This designation is evaluated and potentially renewed at least annually, based on results of the QMP job competency.
  • Employees at the Child/Adolescent Day Treatment programs licensed under HFS §40 are required to have either training in psychiatric nursing, including training in work with children with mental health disorders, or one (1) year of experience working in a clinical setting with these children.

The System also includes Rogers Behavioral Health Foundation, which supports patient care, programs, and researc...

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