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Utilization Review Rn Jobs in Eau Claire, WI (NOW HIRING)

Dove Healthcare

MDS Coordinator - RN

Eau Claire, WI · On-site

$34 - $43.25/hr

MDS Coordinator (RN) Responsibilities Include: * coordinating and monitoring RAI/PPS activity ... utilization review, case management, Medicare, insurance, and VA benefit structure. Health and ...

Dove Healthcare

MDS Coordinator - RN

Eau Claire, WI · On-site

$34 - $43.25/hr

MDS Coordinator (RN) Responsibilities Include: * coordinating and monitoring RAI/PPS activity ... utilization review, case management, Medicare, insurance, and VA benefit structure. Health and ...

Dove Healthcare

MDS Coordinator - RN

Eau Claire, WI · On-site

$34 - $43.25/hr

MDS Coordinator (RN) Responsibilities Include: * coordinating and monitoring RAI/PPS activity ... utilization review, case management, Medicare, insurance, and VA benefit structure. Health and ...

Dove Healthcare

MDS Coordinator - RN

Eau Claire, WI · On-site

$34 - $43.25/hr

MDS Coordinator (RN) Responsibilities Include: coordinating and monitoring RAI/PPS activity ... utilization review, case management, Medicare, insurance, and VA benefit structure.Health and ...

TEEMA Group

Registered Nurse (RN)

Stanley, WI · On-site

$53 - $60/hr

Registered Nurse (RN)Role Summary Are you a resilient, highly analytical Registered Nurse looking ... Prior professional experience navigating behavioral health, substance utilization programs, or ...

TEEMA Group

Registered Nurse - RN

Chippewa Falls, WI · On-site

$54 - $60/hr

Registered Nurse (RN)Role Summary Are you a resilient, highly analytical Registered Nurse looking ... Prior professional experience navigating behavioral health, substance utilization programs, or ...

Elevance Health

Family Care-Registered Nurse

Durand, WI · On-site

... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... Prospective employees required to be screened under Florida law should review the education and ...

Elevance Health

Family Care-Registered Nurse

Durand, WI · On-site

... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... Prospective employees required to be screened under Florida law should review the education and ...

Elevance Health

Family Care-Registered Nurse

Durand, WI · On-site

... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... Prospective employees required to be screened under Florida law should review the education and ...

Elevance Health

Family Care-Registered Nurse

Durand, WI · On-site

... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... Prospective employees required to be screened under Florida law should review the education and ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Eau Claire, WI

Utilization Review Rn information

See Eau Claire, WI salary details

$21

$41

$68

How much do utilization review rn jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review rn in Eau Claire, WI is $41.88, according to ZipRecruiter salary data. Most workers in this role earn between $33.08 and $48.08 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 popular job titles related to Utilization Review Rn jobs in Eau Claire, WI?

For Utilization Review Rn jobs in Eau Claire, WI, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Eau Claire, WI look for?

The top searched job categories for Utilization Review Rn jobs in Eau Claire, WI are:

What cities near Eau Claire, WI are hiring for Utilization Review Rn jobs?

Cities near Eau Claire, WI with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Eau Claire, WI as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 20% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,116 per year, or $41.9 per hour.

Inpatient Utilization Management Specialist

Group Health Cooperative of Eau Claire

Altoona, WI • On-site

Full-time

Medical, Dental, Retirement, PTO

Posted 4 days ago

Job description

Position Purpose
With minimal supervision the Inpatient Utilization Management Specialist assesses, plans, directs, and conducts utilization reviews, discharge planning and transition of care to optimize health care outcomes for our members. Reviews are conducted using evidence-based clinical criteria to determine if admissions and services are medically necessary and a covered benefit under the members health plan. The UM Inpatient Specialist functions as part of an interdisciplinary team. Communicates and documents review determinations in accordance with established policy/procedures, applicable state, federal and accreditation requirements. Relates effectively with others both internally and externally for continuity of care; maintains satisfactory relations with others, maintains accurate and complete records
Essential Position Functions
  • Processes prior authorization and pre-certification requests using tools and resources to determine whether the proposed services meet the clinical requirements for medical necessity, appropriate level of care, health plan benefit coverage, network status, and accuracy.
  • Displays initiative and competence in problem-solving, prioritizing tasks, and managing overall workload.
  • Consults and reviews with Market Leader, CMO, as necessary;
  • Embraces change with a positive attitude;
  • Plans and implements strategies to reduce length of stay and to ensure hospital admissions are medically necessary according to national guidelines;
  • Advocates on behalf of the member regarding accessibility, type, and quality of services within the benefit structure to provide possible solutions to best meet the member’s needs;
  • Works in collaboration with hospital staff and member to ensure discharge and transition of care needs of the member are met;
  • Identify quality events through the utilization review process;
  • Assists member with education needs and in understanding their discharge plan;
  • Communicates effectively with co-workers as well as providers regarding continuity of care, including discharge planning;
  • Attends professional workshops, seminars, and in-service training; transfers knowledge to co-workers;
  • Participates in identifying process areas for improvement, possible solutions, and leads or assists in implementing changes;
  • Maintains member confidentiality by following GHC standards, including HIPAA;
  • Displays empathy and compassion while maintaining policy and benefit specifics;
  • Works well independently and as part of a team. Is helpful, approachable, and team oriented. Maintains good rapport with colleagues, ancillary departments, members, and providers;
  • Completes reviews with timeliness and accuracy of decision-making;
  • Maintains accurate documentation;
  • Maintains a professional demeanor when accepting and prioritizing urgent requests.
Minimum Requirements of the Position
  • Registered nurse (R.N.) with a valid license or experience or education. Experience conducting medical reviews within medical, behavioral health and/or long-term care environments is preferred;
  • Must demonstrate high degree of customer service skills, including excellent verbal and written communication skills;
  • Must be able to work under pressure with strong attention to detail;
  • Ability to learn and adapt in a changing environment with changing priorities;
  • Ability to work with and influence a diverse population.
Group Health Cooperative of Eau Claire complies with applicable Federal civil rights laws and does not discriminate, exclude or treat candidates less favorably on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, or sex (including sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes).
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.

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