RN, Registered Nurse | Utilization Management Specialist
About the role
Join a collaborative team that values flexibility, teamwork, and stepping up for one another. Ensure clinical documentation supports medical necessity and payer requirements, contributing to revenue integrity.
Responsibilities
- Conduct first-level clinical reviews to ensure documentation supports medical necessity and payer requirements.
- Collaborate with interdisciplinary teams including attending physicians, social services, and revenue cycle.
- Participate in daily hospital rounds and contribute to decisions on bill holds, avoidable days, downgrades, and upgrades.
- Engage in special projects and team initiatives after one year in the role.
Requirements
Education: Required - Associate degree in Nursing, Preferred - Bachelor’s degree in Nursing. Experience: Required - Minimum of 2 years in nursing, case management, or utilization management, Preferred - 5–7 years of nursing experience, with 1–2 years in acute care hospital. Licensure: Registered Nurse (RN) licensed to practice in the state of Wisconsin.
Qualifications
Strong critical thinking and decision-making. Ability to work independently and collaboratively. Breadth of clinical knowledge across disease processes. Comfort with fast-paced, detail-oriented work.
Skills
N/A
Benefits
Competitive pay starting at $33.50/hour (plus experience-based increases), shift differentials for weekends, top-rated retirement plan, and tuition support.
Pay
$33.50/hour (plus experience-based increases)
Schedule
Monday–Friday, 8-hour shifts with one day off per week; occasional Saturday coverage