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

Critical Connections

RN - Case Management

Mequon, WI · On-site

About the Opportunity We are seeking an experienced Case Management RN to coordinate patient care, discharge planning, and utilization review in a hospital setting. This role is ideal for nurses who ...

New

Froedtert

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI

$36.38 - $56.39/hr

Assists the case managers with utilization review issues, and provides recommendations for process ... Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from ...

FROEDTERT HEALTH

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

Assists the case managers with utilization review issues, and provides recommendations for process ... Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from ...

UnitiMed

RN Case Manager

Mequon, WI · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

New

Champion Care

Case Management Director

Milwaukee, WI · On-site

... * RN or LPN license highly preferred * Experience in skilled nursing facility (SNF) case management, insurance authorization, managed care, or utilization review required * Strong knowledge of ...

Champion Care

Case Management Director

Milwaukee, WI · On-site

... * RN or LPN license highly preferred * Experience in skilled nursing facility (SNF) case management, insurance authorization, managed care, or utilization review required * Strong knowledge of ...

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How much do utilization review rn jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for utilization review rn in Milwaukee, WI is $41.62, according to ZipRecruiter salary data. Most workers in this role earn between $32.88 and $47.79 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 popular job titles related to Utilization Review Rn jobs in Milwaukee, WI? For Utilization Review Rn jobs in Milwaukee, WI, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Milwaukee, WI look for? The top searched job categories for Utilization Review Rn jobs in Milwaukee, WI are:
What cities near Milwaukee, WI are hiring for Utilization Review Rn jobs? Cities near Milwaukee, WI with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Milwaukee, WI as of June 2026, with employment types broken down into 75% Full Time, 21% Part Time, 2% Contract, and 2% Nights. Highlights an 92% In-person, and 8% Remote job distribution, with an average salary of $86,573 per year, or $41.6 per hour.

RN - Case Management

Critical Connections

Mequon, WI • On-site

Other

Medical, Dental, Vision, Retirement

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

Job description

About the Opportunity
We are seeking an experienced Case Management RN to coordinate patient care, discharge planning, and utilization review in a hospital setting. This role is ideal for nurses who enjoy care coordination, problem-solving, and advocacy.
What You'll Do
  • Coordinate discharge planning and transitions of care
  • Collaborate with physicians, social workers, and payers
  • Ensure appropriate utilization of hospital services
  • Advocate for patient needs and continuity of care
  • Maintain accurate documentation
Qualifications
  • Active RN license
  • Case management or utilization review experience preferred
Compensation & Benefits
  • Competitive weekly pay
  • Guaranteed hours
  • First-day medical, dental, and vision insurance
  • Housing stipend for travel assignments
  • Meals & incidentals stipend
  • License reimbursement
  • Relocation assistance (when applicable)
  • 401(k) retirement plan
  • Short-term and long-term disability insurance
  • Weekly direct deposit

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