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

MDS Coordinator - RN

Eau Claire, WI

$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 ...

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 ...

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 ...

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 ...

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

... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... The RN has overall responsibility to develop the care plan for services for the member and ensures ...

... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... The RN has overall responsibility to develop the care plan for services for the member and ensures ...

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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 Aug 17, 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 knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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:

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, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,116 per year, or $41.9 per hour.

$34 - $43.25/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago


Dove Healthcare rating

6.1

Company rating: 6.1 out of 10

Based on 23 frontline employees who took The Breakroom Quiz

118th of 242 rated social care providers


Job description

Join Dove Healthcare as an MDS Coordinator and take the next step in your career.

This is a hybrid position that will cover our South facility.

We believe time off should not create stress. Our MDS Coordinators are supported by a structured corporate reimbursement team that provides: 

  • dedicated regional reimbursement oversight
  • cross-building MDS support during PTO
  • coverage assistance to prevent backlogs
  • ongoing coding and PDPM education
  • real-time reimbursement analytics support
  • direct access to leadership when needed.

MDS Coordinator (RN) Responsibilities Include:

  • coordinating and monitoring RAI/PPS activity
  • oversight and coordination of Medicare, insurance, VA, and other programs
  • maintaining OBRA and PPS schedules in a timely, accurate and consistent manner and electronic records in accordance with State and Federal rules/regulations and guidelines
  • sharing information related to the quality of medical record documentation to assure the RAI process can be completed
  • maintaining confidentiality of all information related to our residents
  • comply with laws and regulations applicable to position

MDS Coordinator Required Qualifications:

  • one-year MDS experience preferred 
  • current Wisconsin licensure as a registered nurse
  • degree from an accredited school of nursing
  • ability to understand and carry out technical oral and written instructions
  • recognize significant changes in the condition of residents
  • excellent time management skills
  • ability to accept and give directions
  • work well in a team environment
  • a desire to make a difference in people's lives

MDS Coordinator Preferred Qualifications

  • previous experience as an RN is preferred - LPN will be considered
  • prefer a minimum of one year of long-term care experience with working knowledge of the RAI/PPS process and PDPM, whether in a clinical, reimbursement, or managed care capacity, and a background in utilization review, case management, Medicare, insurance, and VA benefit structure.

Health and Wellness Benefits

  • choose your own health insurance - our benefit design offers the flexibility to choose the plan that works best for you and your family!
  • company paid life and AD&D insurance
  • dental and vision Insurance
  • wellness incentives, including onsite gyms, health club reimbursement, weight loss program reimbursement
  • supplemental benefits, including short-term disability, life insurance, critical illness, accident coverage, hospital indemnity, cancer
  • paid time off (PTO)
  • floating holiday
  • employee assistance program (EAP)

Financial Benefits

  • early wage access through DailyPay
  • childcare assistance - up to 20%
  • 401k, with company match
  • financial planning resources
  • referral bonus - up to $700 per referral

Career Development

  • tuition reimbursement / scholarship opportunities
  • continuing education
  • career mapping

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or Veteran status.

About Dove Healthcare

Dove Healthcare consists of 11 skilled nursing and rehabilitation centers, six assisted living residences, and three independent living complexes in Barron, Bloomer, Chippewa Falls, Eau Claire, Fennimore, Lodi, Osseo, Rice Lake, Spooner, St. Croix Falls, and Superior.

Our core services include in-patient and out-patient rehabilitation, post-hospital care, ventilator care, skilled nursing, long-term and end-of-life care, as well as senior independent living, assisted living, and memory care.

As an innovative healthcare provider and community partner, we provide compassionate care and service to meet the needs of those who depend on us. We commit to excellence through adherence to high standards, disciplined leadership, and mutual respect for all.

For more information, visit dovehealthcare.com.


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