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Behavioral Health Utilization Management Jobs in Indiana

SIHO Insurance Services, Inc.

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Utilization Management Nurse

Columbus, IN · On-site

This individual's primary role is to ensure that health care services are administered with quality ... management, utilization review, and medical necessity * Act and perform within the scope of ...

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Behavioral Health Utilization Management information

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$40

$65

How much do behavioral health utilization management jobs pay per hour?

As of Jul 4, 2026, the average hourly pay for behavioral health utilization management in Indiana is $40.23, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.20 per hour, depending on experience, location, and employer.

What is the difference between Behavioral Health Utilization Management vs Behavioral Health Case Manager?

AspectBehavioral Health Utilization ManagementBehavioral Health Case Manager
CredentialsLicenses (e.g., RN, LCSW), certifications in utilization reviewLicenses (e.g., LCSW, LPC), case management certifications
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community clinics, outpatient facilities
Employer & Industry UsageHealth insurance providers, managed care organizationsBehavioral health agencies, hospitals, outpatient clinics

Behavioral Health Utilization Management focuses on reviewing and authorizing mental health services to ensure appropriate care and cost management. In contrast, Behavioral Health Case Managers coordinate ongoing patient care, providing support and resources to improve treatment outcomes. Both roles require relevant licenses and certifications but differ in their primary responsibilities and work settings.

What are some common challenges faced by Behavioral Health Utilization Management professionals, and how are they typically addressed?

Behavioral Health Utilization Management professionals often encounter challenges such as managing high caseloads, keeping up with evolving clinical guidelines, and ensuring timely communication with providers and insurance companies. Balancing the need for cost containment with advocating for appropriate patient care can also be demanding. These challenges are typically addressed through ongoing training, strong teamwork, and the use of evidence-based criteria and decision-support tools to guide determinations and streamline workflows.

What is Behavioral Health Utilization Management?

Behavioral Health Utilization Management is a process used by insurance companies and healthcare organizations to evaluate the necessity, appropriateness, and efficiency of behavioral health services such as mental health and substance use treatments. This process helps ensure that patients receive the right level of care based on clinical guidelines while managing healthcare costs. Utilization managers review treatment plans, authorize services, and coordinate with providers to promote quality outcomes and avoid unnecessary services. Their work is essential in balancing patient needs with resource allocation in the healthcare system.

What are the key skills and qualifications needed to thrive as a Behavioral Health Utilization Management professional, and why are they important?

To thrive as a Behavioral Health Utilization Management professional, you need a background in behavioral health or clinical care, often with an RN, LCSW, LPC, or similar licensure and experience in mental health care settings. Familiarity with utilization review software, insurance guidelines, and electronic health record (EHR) systems is crucial. Strong analytical thinking, communication, and negotiation skills are essential soft skills to effectively evaluate treatment plans and coordinate with providers. These competencies are vital to ensuring appropriate, cost-effective care while maintaining compliance with regulatory and payer requirements.
What are popular job titles related to Behavioral Health Utilization Management jobs in Indiana? For Behavioral Health Utilization Management jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Behavioral Health Utilization Management jobs in Indiana look for? The top searched job categories for Behavioral Health Utilization Management jobs in Indiana are:
What cities in Indiana are hiring for Behavioral Health Utilization Management jobs? Cities in Indiana with the most Behavioral Health Utilization Management job openings:
Behavioral Health Utilization Management jobs near you
Infographic showing various Behavioral Health Utilization Management job openings in Indiana as of June 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% In-person job distribution, with an average salary of $83,687 per year, or $40.2 per hour.
Utilization Management Nurse

Utilization Management Nurse

SIHO Insurance Services

Columbus, IN • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Utilization Management Nurse

Job Title: Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type: Full-Time, Exempt

Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization Management (UM) services for SIHO (and affiliated business lines') members. This individual's primary role is to ensure that health care services are administered with quality, cost effectiveness, and compliance to plan guidelines. By performing review of services prospectively, retrospectively, and throughout the episode of care, the UM nurse will make coverage determinations influencing how services are allocated to SIHO's various member populations. A candidate's ability to perform quality reviews within strict efficiency standards is required for this position. Key responsibilities are as follows:

  • Pre-service, concurrent, and post-service review for medical necessity of health care services utilizing enrollee medical records and established guidelines set by SIHO and/or state and federal (CMS) guidelines
  • Interaction with the member, health care provider, and/or other care team members to complete reviews in most time-efficient manner
  • Interaction with the SIHO Medical Director or external Medical Reviewers as needed to ensure proper medical necessity decisions are made in a timely manner
  • Appropriate documentation of the entire review process utilizing the established documentation system and desk procedures to guarantee accurate reporting metrics and data integrity
  • Complete case review and manage turnaround times to assure determinations are rendered within the contractual and regulatory turnaround times established by SIHO and CMS
  • Assist in problem resolution and provide guidance to members of the team and cohorts
  • Interpret and abide by organizational policies and procedures; review work regularly to ensure that policies and guidelines are appropriately applied
  • Act as a clinical resource to the department and other organization members for services pertaining to medical management, utilization review, and medical necessity
  • Act and perform within the scope of professional nursing practice; display responsibility in supporting and participating in department strategies and efforts focused on quality improvement
  • Responsible for the early identification and assessment of members for inclusion in disease management or care management programs
  • Assist in the identification and reporting of Potential Quality of Care concerns and Fraud, Waste and Abuse incidents
  • Work as an interdisciplinary team member within Medical Management for all lines of business and commercial group plans
  • Show effective prioritization, efficiency and accuracy of work product in alignment with department goals.

Minimum Skills Requirement:

  • Registered Nurse with current, unrestricted license in primary state of employment (position may require additional licensing in other states as necessary)
  • Previous UM or Health Plan experience highly preferred
  • Desire to work in a fast-paced environment with focus on efficiency and attention to detail while maintaining quality
  • Self-directed organizational and prioritization skills, and independent time management skills required
  • Sound clinical background with experience in the clinical field
  • Excellent verbal and written communication skills
  • Microsoft Office Experience: Outlook, Word, Excel

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