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

ThedaCare

Behavioral Health RN - Part Time

Neenah, WI · On-site

Our compassionate team is comprised of Psychiatric hospitalists, RN's, CNA's, Occupational Therapists, mental health therapists, utilization specialists, and administrative professionals. This ...

ThedaCare

PRN - Behavioral Health RN

Neenah, WI · On-site

Our compassionate team is comprised of Psychiatric hospitalists, RN's, CNA's, Occupational Therapists, mental health therapists, utilization specialists, and administrative professionals. This ...

Summit BHC

Full Time RN Nights

Green Bay, WI · On-site

$40 - $50/hr

Full Time RN Nights | Willow Creek Behavioral Health | Green Bay, Wisconsin About the Job: Willow ... transcribes and reviews provider's orders ensuring all required elements are present and ...

Vibra Travels

Travel Nurse RN - Dialysis

Neenah, WI · On-site

Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, days ... Before we submit you, we review the exact compensation package so there are no surprises later in ...

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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 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.

Admissions Registered Nurse (RN)

Moments Hospice

Green Bay, WI • On-site

$75K - $90K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 10 days ago

Moments Hospice rating

8.1

Company rating: 8.1 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

7th of 47 rated hospices

Job description

Admissions RN
Full-Time 

At Moments Hospice, we never want our staff to have to stress about their commute. That's why our winning compensation package includes a fleet car benefit option with gas and insurance covered. Enjoy a vehicle for both business and personal use at a minimal cost to you. We fuel more than just your career when you join our team - apply now! 

Nurses looking for autonomy and variety should consider practicing in Hospice Care. As an Admissions RN, you will join a team that is dedicated to making our patients' final days, weeks, and months as comfortable as possible.

Hours for this position will be Monday-Friday 12:00 pm-8:00 pm

Responsibilities:
  • Participation in the information gathering, analysis, education and form completion aspects of the admissions process
  • Evaluate patients for hospice appropriateness, e.g. medical records review as requested.
  • Obtain agreement for admission of referred patients and families who meet admission criteria.
  • Analyze data collected to facilitate/obtain admission orders
  • Build effective referral source relationships to support the high quality and responsiveness expectations associated with Moments Hospice
  • Maintain clinical and professional competence.
  • Take the initiative in developing effective relationships internally with the appropriate admissions and patient care resource persons.
  • Utilize interpersonal skills to help appropriately educate and address any questions the patient and/or patient's family has concerning hospice and palliative care
Requirements:
  • Valid Registered Nurse (RN) license
  • Driver's license, insurance and vehicle
  • 1-2 years of nursing experience (preferred)
  • Utmost compassion and integrity
  • Currently licensed as a R.N. in the state where duties are performed.
  • Previous hospital, physician practice, LTC or ALF experience
  • Strong Presentation Skills
  • Previous sales or service experience preferred
Benefits:
  • Competitive salary
  • Company car with fuel and insurance covered
  • Generous PTO accruing immediately
  • Comprehensive health, dental, and vision insurance
  • Generous PTO accruing immediately
  • 401(k) with company matching
$75,000 - $90,000 a year
Apply Now: We make it easy for you to apply and join our team. Experience a career that not only meets your professional goals but also provides a supportive community committed to your success.
 

https://momentshospice.com/terms-of-service/

https://momentshospice.com/privacy-agreement/

Job Type: On The Road

#RegisteredNurse #RN #Nurse

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
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