Top 9 Utilization management nurse Jobs in Appleton, Wi

RN Coordinator Utilization Management
Network Health, Inc —Menasha, WI
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science
Weekend RN Coordinator Utilization Management (1.0 FTE)
Network Health, Inc —Menasha, WI
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science
RN Care Manager
Network Health, Inc —Menasha, WI
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
RN - IV Specialist - Outpatient Infusion Center
Bellin Health —Green Bay, WI
- 12 hour shift
- Nursing
- RN License
- Bachelor of Science
- Health insurance
- Tuition reimbursement
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical Care —Neenah, WI
- Full-time
- Nursing
- Heavy lifting
- RN License
- Tuition reimbursement
RN-IV Specialist-Pharmacy Cancer Team
Bellin Health —Green Bay, WI
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Tuition reimbursement
Nurse Clinician 3 - 80%
State of Wisconsin - Corrections —Oshkosh, WI
- $46.00 - $57.23 an hour
- 8 hour shift
- Nursing
- RN License
- BLS Certification
- Paid holidays
- Health insurance
Utilization Management Reviewer
Amerihealth Caritas —United States
- Full-time
- Hybrid work
- Nursing
- Microsoft Outlook
- RN License
- Paid holidays
- Health insurance

More jobs to discover

Find similar jobs that you might be interested in.

Weekend RN Coordinator Utilization Management (1.0 FTE)
Network Health, Inc —Menasha, WI
Collaborate with other NH departments to develop interdepartmental operational processes. Current registered nurse licensure in Wisconsin required.

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

RN, LSW, LISW, Care Manager - Columbus
Careforth —Columbus, OH
Ability and flexibility to travel (usually by car) within assigned geographic area; valid driver’s license and car insurance required.
$62,657 - $84,173 a year
Nurse - Skilled/Purchased Care Coordinator
US Veterans Health Administration —Columbus, OH
Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the…
$70,726 - $148,921 a year
6d

Show more jobs in cities nearby

I want to receive the latest job alert for utilization management nurse in appleton, wi

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization management nurse jobs near appleton, wi

Registered Nurse Infusion jobs in Green Bay, WI

Fertility Nurse jobs in Dayton, OH

Remote Document Review jobs in Michigan

Utilization Review Nurse jobs in Abilene, TX

Utilization Review Nurse jobs in Boca Raton, FL

Utilization Review Nurse jobs in Olympia, WA

Utilization Review Nurse jobs in Fort Lauderdale, FL

Clinical Laboratory Scientist jobs in Torrance, CA

Clinical Psychologist jobs in Washington, DC

Dialysis Clinical Nurse Manager jobs in Juneau, AK

Dialysis Clinical Nurse Manager jobs in Roanoke Rapids, NC

Dialysis Clinical Nurse Manager jobs in Honolulu, HI

Dialysis Clinical Nurse Manager jobs in Chula Vista, CA

Telephone Triage Nurse jobs in Tampa, FL

Nurse Coordinator jobs in North Mankato, MN

Coordinator jobs in Columbus, OH

Nurse Practitioner jobs in Peoria, IL

Nurse Coordinator jobs in Albany, NY

Nurse Coordinator jobs in Rochester, NY

Nurse Coordinator jobs in Grand Junction, CO

RN Coordinator Utilization Management

Network Health, Inc -
Menasha, WI

Apply Now

Job Details

Full-time

Qualifications

Nursing
RN License
Associate's degree
Associate Degree in Nursing
Nursing

Full Job Description

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday

Check out our 2025 Community Report (https://www.youtube.com/watch?v=Oea3uHW0EV0) (https://networkhealth.com/__assets/pdf/2025_annual_report.pdf) to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
Collaborate with other NH departments to develop interdepartmental operational processes
Support Utilization Management department programs and goals through active participation
Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
Evaluate cases for cost savings/quality improvement potential
Other duties and responsibilities as assigned

Job Requirements:

Bachelor of Science in Nursing, preferred
Associate Degree in Nursing, required
Current registered nurse licensure in Wisconsin required
Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
Experience in insurance, managed care and utilization management preferred

Network Health is an Equal Opportunity Employer

Licenses & Certifications

Preferred

Registered Nurse

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 (https://www.eeoc.gov/poster) notice from the Department of Labor.

Apply Now

Refine Your Search

utilization management nurse jobs in appleton, wi

RN Coordinator Utilization Management

Weekend RN Coordinator Utilization Management (1.0 FTE)

RN Care Manager

RN - IV Specialist - Outpatient Infusion Center

Dialysis Clinical Manager Registered Nurse - RN

RN-IV Specialist-Pharmacy Cancer Team

Nurse Clinician 3 - 80%

Utilization Management Reviewer

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for utilization management nurse in appleton, wi

Explore jobs in more locations

Licenses & Certifications

Job Seeker Tools

Employer Tools

Browse

Stay Connected