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Case Manager Utilization Review Nurse Jobs in Decatur, IN

Moments Hospice

RN Case Manger

Fort Wayne, IN · On-site

$75K - $90K/yr

As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

Moments Hospice

RN Case Manger

Fort Wayne, IN

As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

Moments Hospice

RN Case Manger

Fort Wayne, IN

$75K - $90K/yr

As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

Acadia Healthcare

Utilization Assistant

Fort Wayne, IN · On-site

Gather data to support case management activities, including presentation of gathered data and case ... reviews and discharge planning. * Assist physician in peer review by serving as information ...

Acadia Healthcare

Utilization Assistant

Fort Wayne, IN · On-site

Gather data to support case management activities, including presentation of gathered data and case ... reviews and discharge planning. * Assist physician in peer review by serving as information ...

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All JobsCase Utilization Review Nurse JobsCase Manager Utilization Review Nurse JobsCase Manager Utilization Review Nurse Jobs in Decatur, IN

Case Manager Utilization Review Nurse information

See Decatur, IN salary details

$18

$45

$77

How much do case manager utilization review nurse jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for case manager utilization review nurse in Decatur, IN is $45.86, according to ZipRecruiter salary data. Most workers in this role earn between $34.09 and $55.43 per hour, depending on experience, location, and employer.

What is a case manager utilization review nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

What are popular job titles related to Case Manager Utilization Review Nurse jobs in Decatur, IN?

For Case Manager Utilization Review Nurse jobs in Decatur, IN, the most frequently searched job titles are:

What cities near Decatur, IN are hiring for Case Manager Utilization Review Nurse jobs?

Cities near Decatur, IN with the most Case Manager Utilization Review Nurse job openings:

Case Manager Utilization Review Nurse jobs near you
Infographic showing various Case Manager Utilization Review Nurse job openings in Decatur, IN as of August 2026, with employment types broken down into 71% Full Time, 17% Part Time, and 12% Contract. Highlights an 88% In-person, and 12% Remote job distribution, with an average salary of $95,392 per year, or $45.9 per hour.

RN Case Manager

American Health Partners

Fort Wayne, IN

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

New

Job description

The RN Case Manager is primarily responsible for the daily management and support of the Case Management strategies for care coordination for a group of members who are associated with a Medicare Advantage plan. Visit (in person and/or telephonic) patients to ensure proper nursing care. Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims. Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans.

This position requires an individual who is a self-starter and team player, has the ability to manage multiple priorities, work with minimal supervision on assigned projects and activities, and demonstrates excellent communication and presentation skills. This individual must be able to adapt quickly to change and be able to collaborate with multiple teams

Here are a few of our benefits:

  • Annual performance wage increases
  • 401k retirement plan with a company match
  • Medical, dental and vision insurance
  • $50,000 basic life insurance – paid by the company
  • Paid time off
  • UKG Wallet – access your pay faster!
  • Holiday pay
  • Telehealth through 98point6 – free to all employees
  • Continuing Education opportunities
  • Career Advancement Opportunities

Qualifications/Requirements:

  • Minimum of 2 years of experience in clinical nursing or rehabilitation for the geriatric population.
  • 2-years managed care experience required.
  • Minimum of 3-5 years’ experience doing case management in a managed care environment preferably with a managed care organization or like facility, Preferred.

Essential Functions:

  • Complete Health Risk Assessments for members as assigned.
  • Initiate, update and/or revise care plans as needed.
  • Maintain a case load of patient as assigned.
  • Evaluates, coordinates, and plans patient care in collaboration with an interdisciplinary health team; reassesses and revises plans of care in collaboration with other members of the health care team.
  • Provides patient/family education based on identified learning needs utilizing available teaching resources
  • Provides education based on identified learning needs utilizing available teaching resources to members of the Home/Facility staff as needed.
  • Coordinates outpatient discharge planning based on patient needs, clinical circumstances and benefit coverage.
  • Participates in all Managed Care related audits; generates, maintains and tracks periodic and annual reports/documents via MS Office program, e-mails to support Care Coordination program.
  • Performs improvement projects involving development of monitoring/collection tools, review of medical records, data entry, analysis, and preparation of audit findings and reports.
  • Participates in patient care conferences, committee meetings, staff development and educational programs to increase or maintain professional competency.
  • Correctly applies medical management criteria.
  • Researches clinical questions from employers, members and payers as required.
  • Educate members on health access options.
  • Responds, manages, and resolves day-to-day problems presented in care coordination and communicates effectively with the Facility/Home.
  • Other duties as assigned.

Education:

  • Graduate of an accredited RN program.
  • Bachelor’s Degree preferred.

Licensure/Certifications:

  • Current license to practice as a register nurse in assigned state.
  • Current CCM license, Preferred
  • CPR for Healthcare Professionals certification.
  • Current valid driver’s license.
  • Current motor vehicle insurance.
American Health Partners logo

About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

Facebook

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