Top 23 Utilization review Jobs in Madison Wi

Medical Review Nurse Analyst
Wis Phys Svc Ins Corp —Madison, WI
- $68,000 - $70,000 a year
- Remote
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Dental insurance
RN – Clinical Documentation Integrity Specialist
UW Health —Madison, WI
- $83,817 - $125,725 a year
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Paid parental leave
- Health insurance
3d
Medical Director
Wis Phys Svc Ins Corp —Madison, WI
- Hybrid work
- Medicine
- BC/BE
- 3 years
- Health insurance
- Dental insurance
12d
RN Case Manager-Clinical Resource; Child&Adol Psych; 0.0FTE; Day/PM Shift
UnityPoint Health —Madison, WI
- Weekends as needed
- Nursing
- RN License
- Word processing
- Paid holidays
- Disability insurance
LTC PharmacistLTC Pharmacist
Hometown Long Term Care Pharmacy —Sun Prairie, WI
- Mid-level
- Bachelor's degree
- Conflict management
Quick Apply
Primary Care - Internist
Group Health Cooperative of South Central Wisconsin —Madison, WI
- Full-time
- CPR Certification
- Medicine
- BLS Certification
Quick Apply
Medical Director, Perioperative Services - Anesthesia
University of Wisconsin–Madison —Madison, WI
- Full-time
- Medicine
- BC/BE
- Administrative experience
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply
Medicaid Medical Review RN (Medical Reviewer III)
CoventBridge Group —United States
- $65,000 - $70,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- Paid holidays
- Disability insurance

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Registered Nurse - Wound
SSM Health —Madison, WI
Utilizes the nursing process to develop, communicate, implement and/or delegate, and document a care plan for appropriate patients with wound, ostomy,…
11d
Clinical Operations Manager (COM) - PHP/IOP
Rogers Memorial Hospital, Inc. —Madison, WI
Master’s degree in social services or a related field , with an active clinical license issued by the appropriate state licensing board (e.g., Wisconsin…
Quick Apply
9d

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Utilization Management Behavioral Health Professional
Humana —Ohio
Bachelor's degree in nursing OR a master's degree in a Human Services field with a professional individual or compact licensure in the state of Kentucky without…
$65,000 - $88,600 a year
1d
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
3d

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Medical Review Nurse Analyst

Wis Phys Svc Ins Corp -
Madison, WI

Apply Now

Job Details

$68,000 - $70,000 a year

Benefits

Health insurance
Dental insurance
Paid time off
401(k) matching

Qualifications

Nursing
RN License
Caseload management
Nursing

Full Job Description

Our Medical Review Nurse Analyst is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This analyst ensures that providers are being reimbursed appropriately for services provided based on Medicare guidelines. This Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements.

Salary Range
$68,000 - $70,000
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin

How do I know this opportunity is right for me? If you:

Can perform detailed reviews of medical records and documentation to determine the medical necessity of services.
Would enjoy reviewing submitted claims to ensure that billed services are medically necessary and correctly coded based on Medicare guidelines.
Want to ensure Medicare providers are correctly reimbursed when documentation supports services rendered.
Have prepared written clinical summaries and determinations with clear rationale for approvals, denials, or modifications.
Would like to educate providers in accordance with the Targeted Probe and Educate (TPE) program.
Can monitor the progress of assigned providers and educate on current billing and documentation requirements.
Want to ensure compliance with federal and state regulations, CMS guidelines, and company policies.
Enjoy staying current on clinical guidelines, medical policy updates, and industry best practices.

Minimum Qualifications

Associate’s (ASN) or Bachelor’s Degree in Nursing (BSN).
Active RN license, applicable to state of practice in good standing.
1 or more years of clinical experience in a healthcare setting (hospital, homecare, skilled nursing, etc.).
Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
Strong attention to detail and organizational skills to manage multiple cases simultaneously.
Basic knowledge and understanding of medical/clinical review processes.
Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel.

Preferred Qualifications

Experience working for a Medicare Administrative Contractor (MAC).
Familiarity with Medicare guidelines and reimbursement processes.
Experience with medical record review or utilization review.

Remote Work Requirements

Wired (ethernet cable) internet connection from your router to your computer
High speed cable or fiber internet
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net (https://speedtest.net))
Please review Remote Worker FAQs (https://secure.wpsic.com/files/remote-work-faqs.pdf) for additional information

Benefits

Remote work options available
Performance bonus and/or merit increase opportunities
401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
Professional and Leadership Development Programs
Review additional benefits: (https://www.wpshealthsolutions.com/careers/ (https://www.wpshealthsolutions.com/careers/))

Who We Are

WPS, a health solutions company, (https://www.wpshealthsolutions.com/about/index.shtml) is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years (https://www.wpshealthsolutions.com/75/). Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition. (https://www.wpshealthsolutions.com/news/?c=awards)

Sign up for Job Alerts (http://recruiting2.ultipro.com/WIS1003/JobBoard/e6da0c90-f987-63dc-99a9-fb8c9014f57e/Account/Register?cancelUrl=https%3A%2F%2Frecruiting2.ultipro.com%2FWIS1003%2FJobBoard%2Fe6da0c90-f987-63dc-99a9-fb8c9014f57e%2F%3Fq%3DWPS%26o%3Drelevance&redirectUrl=%2FWIS1003%2FJobBoard%2Fe6da0c90-f987-63dc-99a9-fb8c9014f57e%2FJobSearchAgent)

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WPS Health Blog (https://www.facebook.com/WPSHealthSolutions/%22%20/t%20%22_blank%22%EF%BF%BDHYPERLINK%20%22https:/www.wpshealth.com/blog/)

This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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 review jobs in madison wi

Medical Review Nurse Analyst

RN – Clinical Documentation Integrity Specialist

Medical Director

RN Case Manager-Clinical Resource; Child&Adol Psych; 0.0FTE; Day/PM Shift

LTC PharmacistLTC Pharmacist

Primary Care - Internist

Medical Director, Perioperative Services - Anesthesia

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

Medicaid Medical Review RN (Medical Reviewer III)

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