Utilization review nurse jobs in Milwaukee, WI - 93 jobs
All
Utilization Review Nurse
Nurse
Nurse Case Manager
Utilization Review Coordinator
Nurse Liaison
Medical Review Nurse (RN)- Itemized Bill Review
Molina Healthcare Inc. 4.4
Utilization review nurse job in Kenosha, WI
Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care.
ESSENTIAL JOB DUTIES:
* Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing.
* Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions.
* Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers.
* Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues.
* Identifies and reports quality of care issues.
* Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
* Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings.
* Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions.
* Supplies criteria supporting all recommendations for denial or modification of payment decisions.
* Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals.
* Provides training and support to clinical peers.
* Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
REQUIRED QUALIFICATIONS:
* At least 2 years clinical nursing experience, including at least 1 year of utilizationreview, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience.
* Registered Nurse (RN). License must be active and unrestricted in state of practice.
* Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC).
* Experience working within applicable state, federal, and third-party regulations.
* Analytic, problem-solving, and decision-making skills.
* Organizational and time-management skills.
* Attention to detail.
* Critical-thinking and active listening skills.
* Common look proficiency.
* Effective verbal and written communication skills.
* Microsoft Office suite and applicable software program(s) proficiency.
PREFERRED QUALIFICATIONS:
* Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
* Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics.
* Billing and coding experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $29.05 - $67.97 / HOURLY
* Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
$29.1-68 hourly 3d ago
Looking for a job?
Let Zippia find it for you.
Utilization Review (UR) Coordinator PRN
Universal Health Services 4.4
Utilization review nurse job in West Allis, WI
Responsibilities Granite Hills Hospital offers high-quality, patient centered behavioral health care for the greater Milwaukee community. Our 120-bed facility will feature evidence-based treatment for adolescents, adults, and older adults. We are looking for looking for a PRN UtilizationReview (UR) Coordinator to join our new team.
The UR Coordinator has responsibility for organizing and conducting the managed care process. The duties shall be directed toward supporting the hospital's mission in the pursuit of excellence in care/service and will include (but not limited to): conducting timely admission and continued stay record reviews with external payers, utilizing approved criteria to make determinations of medical necessity and level of care planning, verifying active treatment by completing internal audit reviews within approved time frames, assisting the treatment team when indicated in the discharge planning process, and acting as liaison with MD/Clinical Treatment Team and external agencies. Report authorizations, denials, and documentation concerns, as well as collaborate effectively accross departments to minimize denials/facilitate optimal use of hospital resources.
Granite Hills Hospital offers comprehensive benefits such as:
Competitive Compensation
Excellent Medical, Dental, Vision, and Prescription Drug Plan
Generous Paid Time Off
401(K) with company match and discounted stock plan
Career development opportunities within UHS and its Subsidiaries
Education Assistance
Challenging and rewarding work environment
Interested applicants may apply directly through our website ********************************* and apply through the Careers tab.
One of the nation's largest and most respected hospital companies, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Steadily growing from a startup to an esteemed Fortune 500 corporation, UHS today has annual revenue nearing $10 billion. UHS is recognized as one of the World's Most Admired Companies by Fortune; ranked #276 on the Fortune 500, and listed #275 in Forbes inaugural ranking of America's Top 500 Public Companies.
Qualifications
The UR Coordinator position requires:
Education:
Bachelor degree in social work, psychology, or counseling. Master's degree in social work, psychology, or counseling preferred.
LPN/LVN required. ADN, BSN preferred.
Limited or full licensure is preferred.
Experience: Experience in psychiatric or substance abuse treatment preferred. Hospital utilizationreview/utilization management experience required. Experience in settings that include inpatient or partial hospitalization preferred. Familiarity with managed health care process, medical terminology, experience in case management, discharge planning, and/or utilizationreview preferred.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: ************************* or **************.
Licensure/Certification: Must possess a valid Driver's License
Knowledge: Prefer knowledge of the Milwaukee behavioral health marketplace, insurance plans, target markets and referral sources, psychiatric and chemical dependency treatment and, age-specific programming.
$55k-66k yearly est. 20d ago
Nurse Case Manager - Trauma Clinic
Children's Hospital and Health System 4.4
Utilization review nurse job in Milwaukee, WI
At Children's Wisconsin, we believe kids deserve the best.
Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.
We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.
Please follow this link for a closer look at what it's like to work at Children's Wisconsin:
***********************************
The Nurse Case Manager in this newly created position will be working for a unique clinic: Trauma Quality of Life Clinic. Utilizing the case management process, the person is responsible for providing care coordination services to a group of complex, special needs pediatric patients and their families across the continuum of care.
The case manager assesses, plans, implements, coordinates and evaluates the plan of care in partnership with the family and other members of the health care team.
Hours: 7:30 am - 4:00 pm (M-F)
Full time: 40 hours per week
No weekends!
Onsite: Milwaukee main campus
Education:
Bachelor's Degree BSN (or equivalent knowledge) preferred
Experience:
Knowledge of complex, chronic pediatric patients that is generally acquired through 2-3 years of pediatric experience.
Licenses and Certifications:
A current license to practice professional nursing in the State of Wisconsin is required.
Current CPR certification - Basic Life Support (BLS) for Healthcare Providers through American Heart or American Red Cross is required.
Certification as a Case Manager and experience in case management strongly desired.
Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.
Certifications/Licenses:
BLS-Basic Life Support Healthcare Provider - American Heart Association/American Red Cross/National Safety Council, License RN-Registered Nurse (30) - State of Wisconsin
$65k-79k yearly est. Auto-Apply 60d+ ago
Nurse Liaison | Full-time with Benefits
Brightstar Care 4.1
Utilization review nurse job in Milwaukee, WI
Job DescriptionThe Nurse Liaison serves as a critical link between clients, families, healthcare providers, and facilities-ensuring seamless coordination and communication throughout the continuum of care. Core responsibilities include assessing client needs, educating clients and families on care options, and facilitating smooth transitions from hospital to home or rehabilitation. The Nurse Liaison also assists with the admission process of new clients, ensuring all necessary assessments, documentation, and communication are completed to support a safe and timely start of care. Additionally, this role supports discharge planning and advocates quality outcomes that enhance the overall client experience.
We are seeking a dedicated, team-oriented professional who demonstrates initiative, strong interpersonal skills, and a commitment to excellence. This position blends sales, marketing, and clinical expertise-requiring both the business acumen and compassionate insight of a nursing professional to deliver exceptional service and drive meaningful growth.Responsibilities1. Sales, Marketing & Referral Growth
Build and maintain strong referral relationships with healthcare professionals, National Accounts and institutions.
Prospect and establish new referral sources to expand service reach.
Conduct on-site visits to promote BrightStar Care as the preferred provider.
2. Strategic Account Management
Document sales activities and referral outcomes for leadership visibility.
Provide market intelligence on trends, competitors, and growth opportunities.
3. Clinical & Admissions Responsibilities
Professionally manage client admissions in the home and communicate care plans.
Perform initial evaluations and reassessments to ensure appropriate care.
Deliver care in compliance with state regulations and company standards.
Required Skills
Active RN license in Wisconsin.
Proven success in healthcare sales or referral development.
Knowledge of regulatory standards (HIPAA, OSHA, Joint Commission).
Ability to travel within Dane County.
Preferred experience in home health or hospice care.
$65k-78k yearly est. 13d ago
Nursing - Case Manager
Prohealth Care Home Care Office 3.9
Utilization review nurse job in Waukesha, WI
Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details.
Ventura MedStaff benefits represent the care and compassion we provide for our clients.
• Health, dental, vision, life, disability benefits and 401k
• Tax free stipends when applicable
• Gym discounts
• Weekly pay
• $750.00 referral bonus
Please apply or contract us at: *********************** or ************
$64k-79k yearly est. 11d ago
Nurse Paralegal
Wilson Elser 4.4
Utilization review nurse job in Milwaukee, WI
Wilson Elser is a leading defense litigation law firm with more than 1300 attorneys in 43 offices throughout the United States. Founded in 1978, we rank among the top 100 law firms identified by The American Lawyer and 36 in the National Law Journal's survey of the nation's largest law firms. We're also Mansfield Certified Plus.
Our firm is committed to attracting and retaining professionals who value each other and the service we provide by embracing Teamwork, Collaboration, Client Service, and Innovation. If you are a motivated professional looking for a long-term fit where you can grow in a role, and will be valued and empowered, then we invite you to apply to our Nurse Paralegal position in our Milwaukee Office.
The Position
Wilson Elser's Milwaukee Office seeks a Full Time Nurse Paralegal to join our expanding Paralegal Service Center. This Paralegal Service Center supports a wide variety of practice areas, in all of our 44 national offices. This is an excellent opportunity for healthcare professionals seeking to expand their careers and who are interested in gaining fast-paced professional experience with a national law firm. Paralegal training will be provided if needed.
This position may be hybrid if desired, but will require attendance at least one day per month in the Milwaukee office. The hours for this position will be scheduled between 8 a.m. and 5 p.m. Monday - Friday.
Key Responsibilities:
Analyze and summarize medical records
Create medical chronologies and narrative summaries of medical records
Create billing record summaries in Excel
Determine, prepare and organize materials needed for expert witness review
Conduct investigative research on expert witnesses
Qualifications
Licensed RN and Bachelor Degree Required
Nurse Paralegal or Legal Nurse Consultant experience a plus, but paralegal training will be provided if needed
Ability to quickly learn proprietary software systems and databases
Strong written communication skills, including business writing and grammar
Strong critical thinking skills
Excellent organizational skills and a team player
Ability to integrate into a fast-paced environment, manage deadlines and adapt to changing priorities to meet client needs
Proficiency in Microsoft Office Suite (Word, Outlook, Excel)
Why Should You Apply?
Benefits: Outstanding benefits package, including 401k match and generous PTO plan
Career Growth: Ample opportunities for professional development and advancement
Employee Perks: Access to corporate discount plans and other benefits
Wilson Elser welcomes submissions of candidates for our open positions exclusively from recruitment agencies with an active, signed fee agreement who have been granted access to a position through our dedicated Recruitment Agency Portal. We are unable to consider submissions from recruitment agencies without a current (dated as of 7/1/2024) agreement in place. We appreciate your understanding. For collaboration inquiries or to establish an agreement, please contact us at *********************************.
Wilson Elser is committed to a collegial work environment in which all individuals are treated with respect and dignity. It is the Firm's policy that employment will be based on merit, qualifications, and competence. Further, employment decisions will be made without regard to an applicants race, color, age, sex, religion, creed, national origin, ancestry, citizenship, marital status, sexual orientation or preference, gender identity, physical or mental disability, status as a victim of domestic violence, sex offenses, or stalking, past or present service in the uniformed services or application or obligation to serve in the uniformed services, or any other characteristic protected by law.
Wilson Elser endeavors to make the Wilson Elser website accessible to any and all users. You may review our Accessibility Policy here.
California Residents may review our CCPA notice for applicants and employees here.
#ZR
$78k-95k yearly est. Auto-Apply 60d+ ago
Spinal Cord Injury Nurse
Asa Healthcare Staffing
Utilization review nurse job in Milwaukee, WI
We are seeking a compassionate and skilled Medical-Surgical Nurse to join our Spinal Cord Injury (SCI) Unit. As a member of our multidisciplinary team, you will play a crucial role in providing comprehensive care to patients with spinal cord injuries. Your responsibilities will include assessing, planning, implementing, and evaluating nursing care for patients with SCI, ensuring their physical and emotional well-being throughout their stay.
Key Responsibilities:
1. **Patient Care**: Provide direct nursing care to patients with spinal cord injuries, including assessing their condition, monitoring vital signs, administering medications, and implementing prescribed treatments.
2. **Collaboration**: Work closely with physicians, therapists, and other healthcare professionals to develop and implement individualized care plans for patients, focusing on optimizing their recovery and maximizing their independence.
3. **Education**: Educate patients and their families about spinal cord injuries, rehabilitation strategies, and preventative measures to promote optimal health and minimize complications.
4. **Advocacy**: Serve as an advocate for patients with spinal cord injuries, ensuring their needs and preferences are communicated effectively to the healthcare team and addressed promptly.
5. **Documentation**: Maintain accurate and thorough medical records, documenting patient assessments, interventions, and outcomes in accordance with regulatory standards and organizational policies.
6. **Safety and Quality Improvement**: Adhere to safety protocols and quality improvement initiatives to enhance patient care and minimize risks within the SCI unit.
7. **Emotional Support**: Provide emotional support and counseling to patients and their families, helping them cope with the challenges associated with spinal cord injuries and rehabilitation.
Joining our SCI Unit offers a rewarding opportunity to make a meaningful difference in the lives of patients with spinal cord injuries, supporting them on their journey towards recovery and rehabilitation. If you are passionate about providing high-quality care and enhancing the well-being of individuals with complex healthcare needs, we encourage you to apply.
$46k-72k yearly est. 60d+ ago
Nurse Paralegal
Wilson Elser-Business & Legal Professionals
Utilization review nurse job in Milwaukee, WI
Job Description
Wilson Elser is a leading defense litigation law firm with more than 1300 attorneys in 43 offices throughout the United States. Founded in 1978, we rank among the top 100 law firms identified by The American Lawyer and 36 in the National Law Journal's survey of the nation's largest law firms. We're also Mansfield Certified Plus.
Our firm is committed to attracting and retaining professionals who value each other and the service we provide by embracing Teamwork, Collaboration, Client Service, and Innovation. If you are a motivated professional looking for a long-term fit where you can grow in a role, and will be valued and empowered, then we invite you to apply to our Nurse Paralegal position in our Milwaukee Office.
The Position
Wilson Elser's Milwaukee Office seeks a Full Time Nurse Paralegal to join our expanding Paralegal Service Center. This Paralegal Service Center supports a wide variety of practice areas, in all of our 44 national offices. This is an excellent opportunity for healthcare professionals seeking to expand their careers and who are interested in gaining fast-paced professional experience with a national law firm. Paralegal training will be provided if needed.
This position may be hybrid if desired, but will require attendance at least one day per month in the Milwaukee office. The hours for this position will be scheduled between 8 a.m. and 5 p.m. Monday - Friday.
Key Responsibilities:
Analyze and summarize medical records
Create medical chronologies and narrative summaries of medical records
Create billing record summaries in Excel
Determine, prepare and organize materials needed for expert witness review
Conduct investigative research on expert witnesses
Qualifications
Licensed RN and Bachelor Degree Required
Nurse Paralegal or Legal Nurse Consultant experience a plus, but paralegal training will be provided if needed
Ability to quickly learn proprietary software systems and databases
Strong written communication skills, including business writing and grammar
Strong critical thinking skills
Excellent organizational skills and a team player
Ability to integrate into a fast-paced environment, manage deadlines and adapt to changing priorities to meet client needs
Proficiency in Microsoft Office Suite (Word, Outlook, Excel)
Why Should You Apply?
Benefits: Outstanding benefits package, including 401k match and generous PTO plan
Career Growth: Ample opportunities for professional development and advancement
Employee Perks: Access to corporate discount plans and other benefits
Wilson Elser welcomes submissions of candidates for our open positions exclusively from recruitment agencies with an active, signed fee agreement who have been granted access to a position through our dedicated Recruitment Agency Portal. We are unable to consider submissions from recruitment agencies without a current (dated as of 7/1/2024) agreement in place. We appreciate your understanding. For collaboration inquiries or to establish an agreement, please contact us at talentacquisition@wilsonelser.com.
Wilson Elser is committed to a collegial work environment in which all individuals are treated with respect and dignity. It is the Firm's policy that employment will be based on merit, qualifications, and competence. Further, employment decisions will be made without regard to an applicants race, color, age, sex, religion, creed, national origin, ancestry, citizenship, marital status, sexual orientation or preference, gender identity, physical or mental disability, status as a victim of domestic violence, sex offenses, or stalking, past or present service in the uniformed services or application or obligation to serve in the uniformed services, or any other characteristic protected by law.
Wilson Elser endeavors to make the Wilson Elser website accessible to any and all users. You may review our Accessibility Policy here.
California Residents may review our CCPA notice for applicants and employees here.
#ZR
$46k-72k yearly est. 18d ago
Np - 20344722
Granite Hills Hospital
Utilization review nurse job in Milwaukee, WI
Join our team at the 120-bed psychiatric hospital, in the Milwaukee suburb of West Allis. Granite Hills Hospital offers high-quality, patient-centered care for the greater Milwaukee community. With a wide range of treatment for adolescents and adults, our mission is to provide much-needed outcome-focused care for those who need it most.
Our new facility features evidence-based treatment modalities and a multi-disciplinary team led by expert medical professionals. The 120 beds are split into 5 groups of 24 with enclosed outdoor spaces to promote healing.
Granite Hills Hospital offers inpatient and outpatient care. We will help determine the best treatment option for every patient, no matter where they are on their journey to recovery, as we work towards a positive outcome and a healthy life.
Opportunity Details:
• Full-Time, Employed Position
• Adult and Adolescent case load
• Inpatient Setting
• Mon-Fri work schedule, with one weekend coverage per month
• Duties include: rounding, treatment team participation, and medication management
• Qualifications: Certified PMHNP
• Experience preferred
Compensation/Benefits (Employed):
• Competitive Base Compensation with Productivity Bonus potential
• Sign on Bonus
• Comprehensive Medical/Dental/Vision Benefits
• Paid Malpractice Insurance
• PTO, 401k with match, Relocation Assistance and more!
$46k-72k yearly est. 28d ago
FL Nurse I Acute .6 part time nights
CWI Landholdings 3.0
Utilization review nurse job in Milwaukee, WI
At Children's Wisconsin, we believe kids deserve the best.
Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.
We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.
Please follow this link for a closer look at what it's like to work at Children's Wisconsin:
***********************************
This is a part time 12 hour nights float RN position for our Acute Care CRU (Clinical Resource Unit)
Clinical Resource Unit-
The Clinical Resource Unit (CRU) is our internal float team. It consists of direct care staff who works on the various inpatient units. Nurses assigned to Acute Care CRU float to all the acute care units and eventually cross train for the EDTC as well.
Successful float nurses are collaborative, adaptable, positive, and eager for clinical learning development. Our CRU needs new team members who are motivated and rewarded in supporting our unit teams to provide best and safest care to kids.
prefer candidates with at least 1 year acute hospital RN experience-
Orientation will be full time for 6 or more months depending on experience and could be on any shift based on preceptor assignments.
Targeting February 16 or March 16 2026 start date.
Responsibilities include being a partner in the care management team, providing coordination and management of patient care to pediatric patients and families within a continuum of care and delegating patient activities as appropriate within a care management assignment. Graduate of an accredited school of nursing in order to meet the recommended entry level for a professional nurse (or equivalent academic and/or professional experience). A license to practice professional nursing in the State of Wisconsin.
Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.
Certifications/Licenses:
BLS-Basic Life Support Healthcare Provider - American Heart Association/American Red Cross/National Safety Council, License RN-Registered Nurse (30) - State of Wisconsin
$52k-65k yearly est. Auto-Apply 14d ago
Residential Nurse/ATP - FT 1st Shift
Lake County Il 4.5
Utilization review nurse job in Waukegan, IL
The Residential Nurse is a valuable member of our Behavioral Health (ATP) Addiction Treatment Program team who is responsible for providing nursing care to people with mental health and/or substance use diagnoses in a 24-hour behavioral health residential program, including intake assessments, administering medications, and ongoing medical care, providing direct care of clients, including crisis intervention and triage on admission, participating in developing treatment plans with clients, and providing emergency assessments for possible hospitalizations, in addition for supporting medical and psychiatric providers on the unit.
To be successful in this role, we are looking for someone who is
* Conscientious
* Compassionate
* Strong attention to detail
* Behavioral Health experience is a plus
Schedule: 40 hours a week
* Tuesday - Saturday (6:45am-3:15pm)
* A weekly rotation of an on-call schedule will be assigned.
* $5.00 shift differential for working hours deemed eligible for shift and weekend premium.
* Provides triage and medical screening for admissions to the program.
* Provides professional nursing care, including administering medications, according to provider's orders in conformance with recognized nursing techniques and procedures, established standards, and administrative policies of the department.
* Recognizes and interprets symptoms of clients' conditions, reports to appropriate personnel, and assists with remedial measures for adverse developments.
* Conducting point-of-care testing.
* Monitors the collection of urine specimens according to standard precautions.
* Maintains clinical charts including documentation of observations, and medication treatments; reports on the condition of clients; observes and corrects, if possible, environmental factors dealing with comfort and safety.
* Participates in staff meetings and provides input regarding the client's physical condition.
* Is responsible for arranging clinic appointments, chest x-rays, laboratory work, and other medical appointments.
* Makes arrangements for medical transfer of patients to other treatment facilities, as necessary.
* Responds to inquiries, gives appropriate information and referrals, and documents, if necessary
* Facilitates with clients and collaborates with the treatment team to develop, review, and update treatment goals and referrals both internally and externally.
* Organizes and participates in treatment-related clinical conferences and staffings on assigned clients.
* Provide education and direction to clients, family members, and/or significant others.
* Takes responsibility for training in and documenting clinical chart requirements to meet program and state standards.
* Associate's degree, (2) two years experience in general nursing care is required, plus one year of experience in behavioral health is preferred - OR -
* Bachelor's degree or diploma, (1) one year experience in general nursing care required, plus one year of experience in behavioral health field is preferred.
* Illinois Licensure as a (RN) Registered Professional Nurse.
As the largest human service provider in Lake County, we believe that services must be available without barriers. No residents are turned away due to the inability to pay. We believe in providing services in an environment of mutual respect, free of discrimination or bias. Whether assuring accessible and effective care, impacting policy, or assessing and monitoring risks, the Lake County Health Department and Community Health Center has been an essential part of the public health system in Lake County for 60 years. We are looking for passionate, qualified team members who can help make a difference in our agency and, most importantly, in our community.
Additional information about the Lake County Health Department, our culture, and why you should join our team can be found at **********************************************************
At this time, you must live in Illinois or Wisconsin to be eligible to work at Lake County Health Department. You can find our salary grades at ************************************************ For unionized positions, a list of our collective bargaining agreements can be found here: *******************************************************************
Any offer of employment is conditioned on the successful completion of a background screening, drug and alcohol testing and may include a pre-employment medical exam.
The Lake County Health Department and Community Health Center is an Equal Opportunity Employer. We evaluate qualified applicants without regard to race, color, religion, sexual orientation, gender identity or gender expression, national origin, disability, veteran status, and other protected characteristics.
$55k-75k yearly est. 16d ago
Nursing - CCU
St. Francis 4.2
Utilization review nurse job in Milwaukee, WI
Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details.
Ventura MedStaff benefits represent the care and compassion we provide for our clients.
• Health, dental, vision, life, disability benefits and 401k
• Tax free stipends when applicable
• Gym discounts
• Weekly pay
• $750.00 referral bonus
Please apply or contract us at: *********************** or ************
$44k-69k yearly est. 18d ago
2025-2026 Graduate Nurses (1st and 3rd shift available!)
Rogers Memorial Hospital 4.7
Utilization review nurse job in West Allis, WI
New Employee Retention Bonus Up to *$15,000.00 retention bonus available! (New Employee is defined as someone who has not been employed with Rogers for more than six months) Under direct supervision of Registered Nurse, the Graduate nurse (GN) performs professional nursing activities in the care of patients so they may achieve or regain, and then maintain, maximum physical, emotional or social functions. Role functions are governed by the Nurse Practice Act, the Administrative Code (in the state of employment), as well as the professional standards for nursing practice, and the corresponding policies and procedures of Rogers Memorial Hospital (Rogers). The registered nurse seeks consultation with other members of the health team as the patient's condition and treatment goals warrant. He/She, in conjunction with the Patient Accounts department, provides patient information to ensure compliance with federal and state statutes.
Job Duties & Responsibilities:
Program: Mental Health Recovery Adult and Adolescent Inpatient
Click here to learn what a Nursing position at Rogers entails!
Schedule: 24 - 40 hours per week
Shifts Available: AM Shift (7:00am-7:30pm), NOC Shift (7:0pm-7:30am)
Job Duties:
Implement patient care.
Assess patients both physically and mentally.
Collaborate with Psychiatrist, Therapist, Dietitians, and other members of our clinical team to develop appropriate plans of care.
Communicate with patients and their families.
Administer medication.
Education/Training Requirements:
Bachelor degree in nursing (BSN) preferred. Registered nurse temporary permit issued by State Board of Nursing in the state of employment.
American Health Association Healthcare Provider CPR certification or is required within thirty (30) days of date-of-hire. Bi-annual re-certification is required.
Formal training in management of the aggressive patient is required within sixty (60) days of date-of-hire. Annual re-certification is required.
Previous psychiatric experience with children, adolescents and adults is preferred.
At the Hospital's discretion, may be required to hold a qualified medical professional (QMP) designation. Must be deemed competent to serve as a QMP, as outlined in the Medical Staff bylaws of Rogers Memorial Hospital. This designation is evaluated and potentially renewed at least annually, based on results of the QMP job competency.
Employees at the Child/Adolescent Day Treatment programs licensed under HFS §40 are required to have either training in psychiatric nursing, including training in work with children with mental health disorders, or one (1) year of experience working in a clinical setting with these children.
The System also includes Rogers Behavioral Health Foundation, which supports patient care, programs, and research; and Rogers InHealth, an initiative that works to eliminate the stigma of mental health challenges.
*******************************
EOE/MFDV
Equal Employment Opportunity and Affirmative Action - Rogers Behavioral Health (rogersbh.org)
With a career at Rogers, you can look forward to a Total Rewards package of benefits, including:
Health, dental, and vision insurance coverage for you and your family
401(k) retirement plan
Employee share program
Life/disability insurance
Flex spending accounts
Tuition reimbursement
Health and wellness program
Employee assistance program (EAP)
Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Rogers Behavioral Health.
To link to the Machine-Readable Files, please visit
Transparency in Coverage (uhc.com)
$44k-68k yearly est. Auto-Apply 60d+ ago
Nursing - Medsurg
Wimil CSM Ozaukee Hosp-60017
Utilization review nurse job in Mequon, WI
Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details.
Ventura MedStaff benefits represent the care and compassion we provide for our clients.
• Health, dental, vision, life, disability benefits and 401k
• Tax free stipends when applicable
• Gym discounts
• Weekly pay
• $750.00 referral bonus
Please apply or contract us at: *********************** or ************
$46k-72k yearly est. 44d ago
NURSE CASE MANAGER - Full Time
Lakeview Specialty Hosp 3.9
Utilization review nurse job in Waterford, WI
Job Description
The Scope of Practice for the RN Case Manager includes responsibility for management of the assigned patient population through multidisciplinary team leadership, in partnership with the Medical Social Worker.
Oversees the work of the Medical Social Worker in this model.
Leads Care conferences to assure a coordinated plan of care and discharge plan for the patient.
Has overall accountability for care coordination, utilization management, and discharge planning for patients within the assigned caseload, and is a member of the Case Management Team, consisting of the Lead Case Manager, the MD Chair of the UM committee, the Medical Social Worker, and other disciplines involved in the multi-disciplinary care planning for LTAC patients & families.
Key Responsibilities:
Leads Care Conferences, and collaborates with all members of the multidisciplinary team to assure a coordinated plan of care..
Facilitates the establishment of a safe and appropriate Discharge Plan and ensures adequate aftercare services are in place to support the discharge plan, utilizing all available resources. Oversees the Medical Social Worker's involvement in & development of the discharge plan..
Maintains an awareness of funding source needs and status, communicates this information to all relevant parties, and initiates any action required to maintain funding for services in any phase of treatment. Participates in Utilization Management meetings to promote sharing of knowledge base, resources, and to foster creative & team-centered problem-solving for difficult situations.
Maintains communication with all parties relevant to patient care and treatment, and ensures customer satisfaction to the best of ability on all fronts both internal and external.
Accurately and appropriately documents all services provided; maintains current case management notes in the Lakeview system. Assures documentation is timely and accurate for communication and accountability, specifically with regard to patient's discharge plan.
Assumes responsibility for own professional growth; actively supports the mission, philosophy, & goals of the organization.
Adheres to work practices consistent with Lakeview's mission and strategic plan; completes other duties as assigned in a timely manner.
Qualifications:
Minimum of 3 years broad clinical experience, predominately in a medical-surgical setting. Case Management, discharge planning, and utilizationreview experience required. Skill, Knowledge and Abilities: Ability to manage and prioritize variety of tasks, work independently, exercise critical thinking, establish priorities, and meet deadlines. Able to work with staff, patients, and families of varied backgrounds.
Education: Registered Nurse, ADN or BSN.
Licensure: Current WI RN licensure required.
Experience: Experience working in interdisciplinary team approach. Certification in Case Management desirable.
About Lakeview Specialty Hospital & Rehab:
Lakeview Specialty Hospital and Rehab is a Joint Commission Accredited and licensed long term acute care hospital (LTACH) and Inpatient Rehabilitation Hospital (IRF) that has delivered 30 years of innovative programs and extensive services with expertise in medically complex care, neurobehavioral health, rehabilitation, and community supportive living. With superior proficiency in brain injury, rehabilitation and complex respiratory care we are able to help our patients with difficult medical conditions reach their highest level of healing and functional independence possible. Located on more than 80 acres in a rural community outside of Milwaukee in Waterford, Wisconsin. Our peaceful grounds, coupled with tenured, talented and caring staff, lend to the healing and recovery process.
$61k-79k yearly est. 4d ago
Nurse Day Shift
Sheboygan Senior Community 3.5
Utilization review nurse job in Sheboygan, WI
Benefits:
401(k)
401(k) matching
Bonus based on performance
Dental insurance
Flexible schedule
Free food & snacks
Health insurance
Paid time off
Parental leave
Training & development
Tuition assistance
Vision insurance
Wellness resources
The Sheboygan Senior Community offers specialized senior living services to meet the full continuum of social, spiritual, and health-related senior care needs. Residents are surrounded by the comforts of home in four distinct households, with dedicated nurses, therapists, and caregivers providing safety, comfort, and happiness. Located in Sheboygan, WI, our community focuses on creating an enjoyable senior living experience for residents and their loved ones. Role Description This is a full-time, day shift, on-site Nurse role located in Sheboygan, WI at the Sheboygan Senior Community. The Nurse will be responsible for providing specialized care, administering medications, monitoring vital signs, assisting with daily tasks, and ensuring the well-being of residents.
Pay based on Experience and Education (annual pay increase and performance Increase)
LPN License $27 - $31
RN License $30 - $35
Hours: 6 am to 6 PM
Qualifications
Experience in elderly care and specialized senior care services
Knowledge of administering medications and monitoring vital signs
Ability to work well in a team and provide compassionate care
Strong communication and interpersonal skills
Current RN or LPN license in the state of Wisconsin
CPR certification
Experience with electronic health records (EHR) is a plus
SSC offers a full range of benefits to our employees:
Up to $500 per pay period for childcare reimbursement
Health insurance - OPEN Network Copay and HD plans
Free Vision and Dental for SSC staff
A robust PTO plan
Flexible scheduling 12-hour shifts every 3rd weekend rotation
SSC does not mandate, nor do we have agency. Our nursing staff, RN/LPN/CNA, all have an average of 4 years or more of service. SSC turnover is under 30% on average for our nursing departments.
Compensation: $29.00 - $35.00 per hour
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
Sheboygan Senior Community is a faith based, charitable nonprofit serving Sheboygan area seniors since 1962. We provide short-term rehab, assisted living, skilled nursing, and end of life care to 85 residents in 4 households. We are proud to give back to our community through the Walk to End Alzheimer's, Adopt-a-Highway, Casual for a Cause Mondays, and so much more. Our culture is built around the SSC Difference: being the provider of choice, employer of choice, and securing our legacy. Every member of our team helps us achieve our mission which is dedicated to providing compassionate care promoting dignity, safety, and comfort in a faith-based community. We are grateful you are here.
Employee Benefits• Childcare reimbursement up to $1,000 per month• Tuition Reimbursement -We care about your future!• Free Employee Hot Meal Program - Never have to bring a lunch to work!!• Affordable Health Insurance (SSC pays 80% of cost)• Free Vision and Dental for all staff• PTO program
$29-35 hourly Auto-Apply 10d ago
Nurse RSA
Bria Health Services 3.6
Utilization review nurse job in Waukegan, IL
Lake Park Center is a specialized mental health facility where we are seeking to hire a nurse aide. This position will have split days on first and second shift with rotating weekends.
Basic Function:
To support assigned consumers with routine daily care to promote independence in accordance with the consumer's stated recovery plan. To ensure safety of all consumers while they reside at Lake Park Center.
Essential Duties
1. Using written instructions and modeling to facilitate development of independent living skills.
2. Routine familiarization with specific direct care staff interventions as outlined in treatment plans or counseling staff guidance.
3. Employing crisis prevention intervention methods for managing difficult behaviors.
4. Engaging consumers to assess their performance of independent living skills. This may include the use of simple surveys s or ADL skills questionnaires to evaluate a consumers' level of performance for such skills.
5. Supervising and monitoring consumer behavior in the milieu.
6. Documenting or charting specific behaviors or observation of consumer behavior that occur during the shift.
7. Collaborating and communicating frequently with counselors and nurses around programing, shift planning and addressing individual consumer behaviors.
8. Ensuring shift to shift communication of important safety or behavioral management issues.
9. Assisting or facilitating in maintaining cleanliness and orderliness throughout the milieu or setting,
10. Assisting in, facilitating and providing general supervision of consumer participation in scheduled programing and services (smoking time, mealtimes etc.).
11. Engaging new admissions to facilitate their acclimation to the facility and general programing during the 1st day orientation process.
12. Prompt and physically assist, as needed, consumers in keeping their room clean and odor-free by changing bed linens and disposing of trash.
13. Model and teach basic day-to-day living skills including how to organize and maintain personal living space.
14. Prompt and physically assist, as needed, consumers in keeping their appearance appropriate daily by completing Activities of Daily Living (ADLs) including but not limited to; hair combing and brushing,
shampooing and styling, trimming (as desired); nail care; shaving; showering; oral care; picking out dressing in clean clothes that are appropriate for the season and in good condition as well as sending dirty clothing to the laundry.
Model and teach basic day-to-day independent living skills sets such as personal hygiene or dressing according to setting, planned activity, or weather conditions.
15. Prompt and facilitate consumers preparation and follow-through with transportation appointments.
16. Prompt and physically assist, as needed, preparing consumers for meals; including but not limited to serving food and drinks and cleaning up after meals.
17. Serve between meal and bedtime snacks or nourishments.
18. Wash hands before and after performing any service for the resident and follow infection control guidelines and universal precautions.
19. Follow established isolation precautions and procedures.
20. Follow established safety precautions in performance of all duties.
21. Treat all consumers, staff, visitors/families, with kindness, dignity, and respect.
22. Any additional tasks as assigned by supervisor that need to be completed to ensure safety and wellbeing of all consumers in the building.
Record Keeping:
1. Measure vitals as instructed by supervisor or on duty nurse.
2. Maintain confidentiality of all resident call information and ensure resident privacy.
3. Maintain records accurately and timely.
4. Chart timely and accurately.
5. Observe and report the presence of skin breakdown or redness immediately to the nurse on duty.
6. Observe and report to supervisor any physical and emotional changes observed in consumers including any complaints or grievances made by consumers.
7. Review care plans daily to ensure provision of appropriate care.
8. Report all hazardous conditions and equipment to supervisor/nurse on duty/receptionist immediately.
Requirements
Qualifications:
· Requires employee to have had no abuse convictions.
· Prompt and regular attendance.
. The position offers two shifts on days from 7am to 3pm and two shifts on evenings from 3pm - 11pm with rotating weekends.
$52k-69k yearly est. 4d ago
Weekend Nurses
Dimensions Home Health
Utilization review nurse job in Gurnee, IL
At Dimensions Home Health Care, our mission is to inspire hope and improve the quality of life for those patients entrusted to our care. We provide home health care under Medicare and Private Insurance to patients in their home; be it a single-family home, apartment building or assisted living.
Our Registered Nurses, Therapists, and Social Worker coordinate care in Lake & McHenry County in Illinois and Kenosha, Racine & Walworth County in Wisconsin.We work with hospitals, skilled nursing providers and primary physicians to continuously assess medical conditions; ensure medication compliance by educating patients and caregivers on the purpose, frequency, proper administration, and possible side effects of medications; all while maintaining a level of care, compassion and consistency that dramatically improves the quality of life of our patients.
We are very proud of the level of care and professionalism we provide and are seeking new energetic and motivated team members to join us as we continue to provide great home health care.
Job Description
Weekend nurses needed immediately.
Qualifications
Must have home care experience.
Must be a registered nurse in Illinois, Wisconsin or both.
Exceptional Pay.
Additional Information
All your information will be kept confidential according to EEO guidelines. Please include salary requirements with your application.
$46k-72k yearly est. 1d ago
Nurse Day Shift
Sheboygan Senior Community 3.5
Utilization review nurse job in Sheboygan, WI
Job DescriptionBenefits:
401(k)
401(k) matching
Bonus based on performance
Dental insurance
Flexible schedule
Free food & snacks
Health insurance
Paid time off
Parental leave
Training & development
Tuition assistance
Vision insurance
Wellness resources
The Sheboygan Senior Community offers specialized senior living services to meet the full continuum of social, spiritual, and health-related senior care needs. Residents are surrounded by the comforts of home in four distinct households, with dedicated nurses, therapists, and caregivers providing safety, comfort, and happiness. Located in Sheboygan, WI, our community focuses on creating an enjoyable senior living experience for residents and their loved ones.
Role Description
This is a full-time, day shift, on-site Nurse role located in Sheboygan, WI at the Sheboygan Senior Community. The Nurse will be responsible for providing specialized care, administering medications, monitoring vital signs, assisting with daily tasks, and ensuring the well-being of residents.
Pay based on Experience and Education (annual pay increase and performance Increase)
LPN License $27 - $31
RN License $30 - $35
Hours: 6 am to 6 PM
Qualifications
Experience in elderly care and specialized senior care services
Knowledge of administering medications and monitoring vital signs
Ability to work well in a team and provide compassionate care
Strong communication and interpersonal skills
Current RN or LPN license in the state of Wisconsin
CPR certification
Experience with electronic health records (EHR) is a plus
SSC offers a full range of benefits to our employees:
Up to $500 per pay period for childcare reimbursement
Health insurance - OPEN Network Copay and HD plans
Free Vision and Dental for SSC staff
A robust PTO plan
Flexible scheduling 12-hour shifts every 3rd weekend rotation
SSC does not mandate, nor do we have agency. Our nursing staff, RN/LPN/CNA, all have an average of 4 years or more of service. SSC turnover is under 30% on average for our nursing departments.
$38k-63k yearly est. 11d ago
Weekend Nurses
Dimensions Home Health
Utilization review nurse job in Gurnee, IL
At Dimensions Home Health Care, our mission is to inspire hope and improve the quality of life for those patients entrusted to our care. We provide home health care under Medicare and Private Insurance to patients in their home; be it a single-family home, apartment building or assisted living.
Our Registered Nurses, Therapists, and Social Worker coordinate care in Lake & McHenry County in Illinois and Kenosha, Racine & Walworth County in Wisconsin.We work with hospitals, skilled nursing providers and primary physicians to continuously assess medical conditions; ensure medication compliance by educating patients and caregivers on the purpose, frequency, proper administration, and possible side effects of medications; all while maintaining a level of care, compassion and consistency that dramatically improves the quality of life of our patients.
We are very proud of the level of care and professionalism we provide and are seeking new energetic and motivated team members to join us as we continue to provide great home health care.
Job Description
Weekend nurses needed immediately.
Qualifications
Must have home care experience.
Must be a registered nurse in Illinois, Wisconsin or both.
Exceptional Pay.
Additional Information
All your information will be kept confidential according to EEO guidelines. Please include salary requirements with your application.
How much does a utilization review nurse earn in Milwaukee, WI?
The average utilization review nurse in Milwaukee, WI earns between $52,000 and $87,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000.
Average utilization review nurse salary in Milwaukee, WI
$67,000
What are the biggest employers of Utilization Review Nurses in Milwaukee, WI?
The biggest employers of Utilization Review Nurses in Milwaukee, WI are: