Milwaukee, WI · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.
Milwaukee, WI · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.
Menomonee Falls, WI · On-site
$36.38 - $56.39/hr
Medical
Dental
Vision
Life
Retirement
PTO
Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.
Menomonee Falls, WI · On-site
$36.38 - $56.39/hr
Medical
Dental
Vision
Life
Retirement
PTO
Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.
$150 - $155/hr
Address clinical risk management, utilization review, and medical grievances as needed
New
Quick apply
$150 - $155/hr
Address clinical risk management, utilization review, and medical grievances as needed
New
Milwaukee, WI · On-site
Medical
Dental
Vision
Life
Retirement
PTO
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
Milwaukee, WI · On-site
Medical
Dental
Vision
Life
Retirement
PTO
As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise clients on network strategy, provider capacity,utilizationtrends, access challenges, and market ...
Oconomowoc, WI · On-site
PTO
Communicate with the Utilization Review department to provide information necessary to assist in facilitate payment for services, if warranted. * Establish and maintain strong lines of communication ...
Oconomowoc, WI · On-site
PTO
Communicate with the Utilization Review department to provide information necessary to assist in facilitate payment for services, if warranted. * Establish and maintain strong lines of communication ...
Oconomowoc, WI · On-site
PTO
Communicate with the Utilization Review department to provide information necessary to assist in facilitate payment for services, if warranted. * Establish and maintain strong lines of communication ...
Oconomowoc, WI · On-site
PTO
Communicate with the Utilization Review department to provide information necessary to assist in facilitate payment for services, if warranted. * Establish and maintain strong lines of communication ...
Glendale, WI · On-site
$300 - $400/hr
Implement utilization review and quality improvement systems. Implement educational programs and offerings. * Maintain a hands-on connection to patient care by providing medical services in an ...
Glendale, WI · On-site
$300 - $400/hr
Implement utilization review and quality improvement systems. Implement educational programs and offerings. * Maintain a hands-on connection to patient care by providing medical services in an ...
Address clinical risk management, utilization review, and medical grievances as needed Top Reasons to Choose a Locum Tenens Assignment * Bridge employment gaps or transitions between permanent ...
Address clinical risk management, utilization review, and medical grievances as needed Top Reasons to Choose a Locum Tenens Assignment * Bridge employment gaps or transitions between permanent ...
Address clinical risk management, utilization review, and medical grievances as needed Top Reasons to Choose a Locum Tenens Assignment * Cultivate meaningful relationships with patients from diverse ...
Address clinical risk management, utilization review, and medical grievances as needed Top Reasons to Choose a Locum Tenens Assignment * Cultivate meaningful relationships with patients from diverse ...
Milwaukee, WI · On-site
$155/hr
Medical
Retirement
Address clinical risk management, utilization review, and medical grievances as needed Top Reasons to Choose a Locum Tenens Assignment * Avoid the hassle of permanent relocation by taking on ...
Milwaukee, WI · On-site
$155/hr
Medical
Retirement
Address clinical risk management, utilization review, and medical grievances as needed Top Reasons to Choose a Locum Tenens Assignment * Avoid the hassle of permanent relocation by taking on ...
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
Collaborates with the System and Region Director(s) of Utilization Management to ensure cohesive workflows between care management and utilization review; Applies strategies within daily operations ...
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
Collaborates with the System and Region Director(s) of Utilization Management to ensure cohesive workflows between care management and utilization review; Applies strategies within daily operations ...
Oconomowoc, WI · On-site
Medical
Dental
Vision
Life
Retirement
Communicate with utilization review (UR), admitting and clinical leadership regarding the quality of documentation within the medical record. * Collaborate with admitting and clinical leadership in ...
Oconomowoc, WI · On-site
Medical
Dental
Vision
Life
Retirement
Communicate with utilization review (UR), admitting and clinical leadership regarding the quality of documentation within the medical record. * Collaborate with admitting and clinical leadership in ...
Milwaukee, WI · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Milwaukee, WI · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Milwaukee, WI · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Milwaukee, WI · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Performs utilization review of continuous care and inpatient levels of care for all patients on team. Customer Service/Sales/Marketing * Assures that problems/grievances/service failures experienced ...
Wauwatosa, WI · On-site
Serves on Quality Improvement and Safety Committees that include Patient/Resident Standards of Care, Pharmaceutical Services, Infection Control, Safety and Utilization Review/PPS. * Meets with ...
Quick apply
Wauwatosa, WI · On-site
Serves on Quality Improvement and Safety Committees that include Patient/Resident Standards of Care, Pharmaceutical Services, Infection Control, Safety and Utilization Review/PPS. * Meets with ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
Brookfield, WI · On-site +1
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
Brookfield, WI · On-site +1
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
Brookfield, WI · On-site +1
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
Brookfield, WI · On-site +1
In coordination with the CMO and Directors of Health Management and QI and Disease Management, share responsibility for the development and continued evaluation of utilization review and quality ...
Milwaukee, WI · On-site
$150K/yr
Medical
Dental
Vision
Retirement
PTO
Monitor the dispatch board daily to ensure proper scheduling, load balancing, and technician utilization. * Review scheduling efficiency, job flow, and capacity planning to minimize downtime and ...
Milwaukee, WI · On-site
$150K/yr
Medical
Dental
Vision
Retirement
PTO
Monitor the dispatch board daily to ensure proper scheduling, load balancing, and technician utilization. * Review scheduling efficiency, job flow, and capacity planning to minimize downtime and ...
$21.03 - $25.28
2% of jobs
$25.28 - $29.54
9% of jobs
$32.45 is the 25th percentile. Wages below this are outliers.
$29.54 - $33.79
21% of jobs
The median wage is $37.23 / hr.
$33.79 - $38.04
23% of jobs
$38.04 - $42.30
13% of jobs
$45.60 is the 75th percentile. Wages above this are outliers.
$42.30 - $46.55
10% of jobs
$46.55 - $50.80
8% of jobs
$50.80 - $55.06
5% of jobs
$55.06 - $59.31
5% of jobs
$59.31 - $63.56
2% of jobs
$63.56 - $67.82
2% of jobs
$21
$41
$67
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.
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.
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.
The most popular types of Utilization Review jobs in Milwaukee, WI are:
For Utilization Review jobs in Milwaukee, WI, the most frequently searched job titles are:
The top searched job categories for Utilization Review jobs in Milwaukee, WI are:
Cities near Milwaukee, WI with the most Utilization Review job openings:
Part-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 25 days ago
Discover. Achieve. Succeed. #BeHere
Location: US:WI:MILWAUKEE at our FROEDTERT HOSPITAL facility.
This job is REMOTE.
FTE: 0.500000
Standard Hours: 20.00
Shift: Shift 1
Shift Details: 1/2 day Wednesday, Thursday and Friday Holidays: no Weekends: no
Job Summary:
Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.
EXPERIENCE DESCRIPTION:
A minimum of 5 years of acute care nursing experience is required. Prior utilization management, insurance background, and denial management experience is preferred.
EDUCATION DESCRIPTION:
Bachelor's degree is required. Professional knowledge of nursing theory and practice at a level normally acquired through completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse is required.
TRAINING DESCRIPTION:
Previous experience with clinical validation denial review and appeal processes. Knowledge of ICD-10 Coding Guidelines.
SPECIAL SKILLS DESCRIPTION:
Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel. Analytical skills necessary to prepare statistical reports and develop solutions to problems. Technical writing ability for appeal letters and reports.
LICENSURE DESCRIPTION:
Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).
Compensation, Benefits & Perks at Froedtert Health
Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following:
The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.
We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.
Employment Type: OTHER
Sourced by ZipRecruiter
Froedtert is a world-class healthcare organization based in Milwaukee, WI, United States. The company operates within the healthcare and wellness industry, providing a broad spectrum of medical services to the residents of southeastern Wisconsin and beyond. Froedtert was founded in 1980 and is an academic health network, which ripples an integrated affiliation with the Medical College of Wisconsin. The company prides itself on its cutting-edge treatments, sophisticated technology, and groundbreaking research. Froedtert’s mission is to advance health in the communities they serve, with a profound commitment towards patient care, education, research and community outreach.
Health care and social assistance
1,001 - 5,000 Employees
Milwaukee, WI, US
1980
