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Utilization Review Jobs in Madison, WI (NOW HIRING)

Medica

Manager, Clinical Pharmacy (Governance)

Madison, WI · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Therapeutic class reviews * Comparative effectiveness assessments * Financial and utilization considerations (in partnership with analytics/actuarial/finance) * Develop clear, defensible, evidence ...

Stoughton Trailers

Coord - Fleet

Stoughton, WI · On-site

Review invoices and attach to asset history * Communicate with various departments regarding ... Forklift utilization, etc Qualifications * Education: High School degree or GED equivalent

Westphal & Co.

Accounting Manager

Madison, WI · On-site

$90K - $110K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Prepare and review journal entries, reconciliations, and supporting documentation. Partner with the ... equipment utilization, and cost entries. Coordinate with third-party accountants on asset ...

Stoughton Trailers

Coord - Fleet

Stoughton, WI · On-site

Review invoices and attach to asset history * Communicate with various departments regarding ... Forklift utilization, etc Qualifications * Education: High School degree or GED equivalent

Medica

Director, Actuarial Services

Madison, WI · On-site

$150K - $257K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Reviews the work of analysts and other credentialed actuaries for reasonability, appropriateness ... Uses appropriate benchmarks when analyzing utilization and provider data * Provides the ...

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Showing results 41-60

All JobsUtilization Review JobsUtilization Review Jobs in Madison, WI

Utilization Review information

See Madison, WI salary details

$21

$42

$69

How much do utilization review jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for utilization review in Madison, WI is $42.60, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $48.94 per hour, depending on experience, location, and employer.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Madison, WI?

The most popular types of Utilization Review jobs in Madison, WI are:

What are popular job titles related to Utilization Review jobs in Madison, WI?

For Utilization Review jobs in Madison, WI, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Madison, WI look for?

The top searched job categories for Utilization Review jobs in Madison, WI are:

What cities near Madison, WI are hiring for Utilization Review jobs?

Cities near Madison, WI with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Madison, WI as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $88,617 per year, or $42.6 per hour.

Retail Staff Pharmacist Part Time or Relief

Hometown Pharmacy

Janesville, WI • On-site

$54.75 - $64.50/hr

Other

Re-posted 7 days ago

Job description

Staff Pharmacist – Make a Difference Every Day
Are you a patient-focused, clinically driven pharmacist looking to practice at the top of your license in a supportive, community-centered environment? At Hometown Pharmacy, our Staff Pharmacists play a vital role in delivering safe, personalized care while collaborating with a dedicated healthcare team.
This role is ideal for a pharmacist who values clinical excellence, teamwork, and meaningful patient relationships—not just volume.
What You’ll Do
  • Safely and accurately dispense prescriptions in a retail pharmacy setting
  • Review and evaluate physician medication orders for appropriateness, dosing, interactions, and stability
  • Conduct Drug Utilization Reviews (DUR) and resolve clinical edits to prevent adverse drug events
  • Communicate recommendations for therapy changes to prescribers and healthcare staff
  • Transfer prescriptions and respond to incoming physician and clinical calls
  • Maintain accurate and complete patient profiles, including medical history, lab data, and medication lists
  • Collaborate with pharmacy technicians to reconcile and manage controlled substances in compliance with state and federal regulations
  • Provide clinical guidance to internal and external partners, including technicians, nursing staff, administrators, and providers
  • Document all clinical communication in patient medical records
  • Support cost-containment and efficiency initiatives (pre-pack, cycle fill, front-end processes, etc.)
  • Assist in implementing policies for safe procurement, storage, dispensing, and disposal of medications
  • Partner with the healthcare team to improve outcomes and enhance the patient experience
Leadership & Team Support
  • Provide day-to-day guidance and oversight to pharmacy technicians and support staff
  • Promote teamwork, accountability, and a culture of safety and service
  • Support training, coaching, and workflow optimization as needed
What You Bring
Required Qualifications
  • BS or PharmD in Pharmacy
  • Active Wisconsin Pharmacist License
  • Strong knowledge of pharmacy laws, regulations, and best practices
Preferred Qualifications
  • 3+ years of pharmacy or supervisory experience
  • Immunization certification in Wisconsin
  • Experience with RX30 and/or PioneerRx
  • Interest in proactive healthcare and nutraceuticals
Skills That Set You Apart
  • Excellent interpersonal and communication skills
  • Strong clinical judgment and attention to detail
  • Ability to manage multiple priorities in a fast-paced environment
  • Action-oriented problem solver
  • High ethical standards and customer-focused mindset
  • Comfortable working independently while collaborating with a team
Why You’ll Love Working at Hometown Pharmacy
  • Friendly, knowledgeable, and supportive work environment
  • Opportunity to practice meaningful, patient-centered pharmacy
  • Leadership that values your clinical expertise and judgment
  • Ongoing training and continuing education opportunities
  • Tools and technology to help you succeed
Work Environment & Tools Provided
  • Computer and pharmacy software
  • Telephone and basic office supplies
  • Collaborative, community-focused pharmacy setting
Professional Expectations
  • Maintain strict confidentiality of patient and business information
  • Follow all pharmacy laws, ethical standards, and company policies
  • Complete required training and continuing education
Physical Requirements
  • Ability to stand for the duration of your shift
  • Ability to lift and carry up to 20 pounds

Join a Pharmacy That Values You
At Hometown Pharmacy, our Staff Pharmacists are trusted clinicians, valued team members, and essential to our mission of improving lives through exceptional care. If you’re ready to work in an environment where your expertise matters, we’d love to meet you.
Apply today and grow your pharmacy career with us.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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