The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Review incoming specialty medication referrals to identify insurance requirements, prior ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Review incoming specialty medication referrals to identify insurance requirements, prior ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Review incoming specialty medication referrals to identify insurance requirements, prior ...
Quick apply
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Review incoming specialty medication referrals to identify insurance requirements, prior ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Review incoming specialty medication referrals to identify insurance requirements, prior ...
The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Review incoming specialty medication referrals to identify insurance requirements, prior ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Registered Nurse Utilization Review
Carmel, IN · On-site +1
$50 - $52/hr
May prepare statistical analysis and utilization review reports as necessary. * Oversee and ... Benefits Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits ...
Registered Nurse Utilization Review
Carmel, IN · On-site +1
$50 - $52/hr
May prepare statistical analysis and utilization review reports as necessary. * Oversee and ... Benefits Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... thorough review of the total resources available to patient pre and post-discharge from ... Documents all insurance information appropriately on forms and in computer system as applicable.
... thorough review of the total resources available to patient pre and post-discharge from ... Documents all insurance information appropriately on forms and in computer system as applicable.
... thorough review of the total resources available to patient pre and post-discharge from ... Documents all insurance information appropriately on forms and in computer system as applicable.
Quick apply
... thorough review of the total resources available to patient pre and post-discharge from ... Documents all insurance information appropriately on forms and in computer system as applicable.
... thorough review of the total resources available to patient pre and post-discharge from ... Documents all insurance information appropriately on forms and in computer system as applicable.
... thorough review of the total resources available to patient pre and post-discharge from ... Documents all insurance information appropriately on forms and in computer system as applicable.
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
... thorough review of the total resources available to patient pre and post-discharge from ... Documents all insurance information appropriately on forms and in computer system as applicable.
... thorough review of the total resources available to patient pre and post-discharge from ... Documents all insurance information appropriately on forms and in computer system as applicable.
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Medical, Dental, and Vision Insurance * NPH 401(k) plan with up to 4% Company match * Employee ... Minimum of 2 years of utilization review experience in a hospital setting required. Minimum of 2 ...
Arranging physician-to-physician clinical reviews with insurance company, Medical Director and ... Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization ...
Arranging physician-to-physician clinical reviews with insurance company, Medical Director and ... Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization ...
Insurance Utilization Review information
See Indiana salary details
$20.36 - $24.48
2% of jobs
$24.48 - $28.59
9% of jobs
$31.41 is the 25th percentile. Wages below this are outliers.
$28.59 - $32.71
21% of jobs
The median wage is $36.04 / hr.
$32.71 - $36.83
23% of jobs
$36.83 - $40.94
13% of jobs
$44.15 is the 75th percentile. Wages above this are outliers.
$40.94 - $45.06
10% of jobs
$45.06 - $49.18
8% of jobs
$49.18 - $53.30
5% of jobs
$53.30 - $57.41
5% of jobs
$57.41 - $61.53
2% of jobs
$61.53 - $65.65
2% of jobs
$20
$40
$65
How much do insurance utilization review jobs pay per hour?
As of Sep 2, 2026, the average hourly pay for insurance utilization review 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 an insurance utilization review?
An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.
What are the key skills and qualifications needed to thrive in insurance utilization review?
To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.
What are the most common challenges faced by insurance utilization review professionals?
One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.
How do I get into an insurance utilization review?
To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.
Is insurance utilization review a stressful job?
Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.
What are the most commonly searched types of Insurance Utilization Review jobs in Indiana?
The most popular types of Insurance Utilization Review jobs in Indiana are:
What are popular job titles related to Insurance Utilization Review jobs in Indiana?
For Insurance Utilization Review jobs in Indiana, the most frequently searched job titles are:
- Utilization Review Physician
- Contract Utilization Review Nurse
- Night Utilization Review Nurse
- Remote Concurrent Review Nurse
- Remote Utilization Review Social Worker
- Flex Schedule Remote Utilization Review Nurse
- Part Time Utilization Review Nurse
- Per Diem Utilization Review Nurse
- Remote Medical Record Review Nurse
- Remote Utilization Review Rn
What job categories do people searching Insurance Utilization Review jobs in Indiana look for?
The top searched job categories for Insurance Utilization Review jobs in Indiana are:
What cities in Indiana are hiring for Insurance Utilization Review jobs?
Cities in Indiana with the most Insurance Utilization Review job openings:
Full-time
Posted 19 days ago
Job description
About IHTC
At the Innovative Hematology (IHI), we offer a future where people with rare blood disorders flourish. Our experts provide the highest quality comprehensive services and holistic care to patients with bleeding, clotting and other hematologic disorders, and to their families.
What You Will Do
As the Utilization Review Specialist, you will be responsible for managing prior authorizations, medical necessity reviews, and payer-related requirements for specialty medications. This role works collaboratively with prescribers, pharmacists, clinic staff, and payers to facilitate timely access to medications while ensuring compliance with insurance guidelines, regulatory requirements, and organizational policies. The Utilization Review Specialist serves as a key resource in minimizing prescription delays, supporting reimbursement efforts, optimizing patient outcomes, and minimizing claim denials.
The Opportunity
Knowledge:
Skills:
Abilities:
Requirements
Benefits
IHI is a not-for-profit program based in Indianapolis and offers a competitive salary and benefit package.
IHI is the only ederally designated comprehensive hemophilia program in Indiana, and serves the entire state through services available in Indianapolis and at outreach clinics.
IHI is a leader in hemophilia care, education and clinical research and has a dedicated on-site multidisciplinary staff to ensure availability of a wide range of required services.
IHI participates in national and international clinical research, including new infusion products and therapies, investigation of long-term outcomes, and the impact of associated conditions. The IHTC research program provides patients access to new therapies, and an opportunity to improve care. Our center has more than 70 clinical research projects involving bleeding disorders, sickle cell disease, thrombosis and more.
The Indiana Hemophilia and Thrombosis Center is an Equal Opportunity Employer.
At the Innovative Hematology (IHI), we offer a future where people with rare blood disorders flourish. Our experts provide the highest quality comprehensive services and holistic care to patients with bleeding, clotting and other hematologic disorders, and to their families.
What You Will Do
As the Utilization Review Specialist, you will be responsible for managing prior authorizations, medical necessity reviews, and payer-related requirements for specialty medications. This role works collaboratively with prescribers, pharmacists, clinic staff, and payers to facilitate timely access to medications while ensuring compliance with insurance guidelines, regulatory requirements, and organizational policies. The Utilization Review Specialist serves as a key resource in minimizing prescription delays, supporting reimbursement efforts, optimizing patient outcomes, and minimizing claim denials.
The Opportunity
- Review incoming specialty medication referrals to identify insurance requirements, prior authorization needs, benefit limitations, coverage exclusions, and payer-specific criteria.
- Conduct utilization review activities to assess medical necessity, appropriateness of therapy, and compliance with payer policies, clinical guidelines, and formulary requirements.
- Initiate, prepare, submit, and track prior authorization requests for specialty medications through electronic portals, fax submissions, and verbal payer reviews.
- Gather, analyze, and validate clinical documentation including chart notes, laboratory results, diagnostic testing, treatment history, and provider assessments to support authorization requests.
- Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical information and ensure complete and accurate submissions.
- Monitor authorization status and proactively follow up with insurance carriers, pharmacy benefit managers (PBMs), and third-party administrators to expedite approvals and minimize delays in therapy initiation.
- Review payer-specific coverage criteria and determine documentation requirements for specialty therapies used in the treatment of hemophilia, von Willebrand disease, sickle cell disease, and other rare hematologic and bleeding disorders.
- Evaluate denials and identify opportunities for appeal by reviewing payer rationale, medical records, and applicable clinical guidelines.
- Prepare and submit first-level, second-level, and external appeal requests, including letters of medical necessity and supporting clinical documentation.
- Maintain detailed records of authorization activities, payer communications, approval dates, denial reasons, appeal outcomes, and reauthorization requirements within pharmacy and electronic health record systems.
- Track authorization expiration dates and proactively initiate renewal activities to ensure uninterrupted patient access to therapy.
- Coordinate with clinical pharmacists and providers to address step therapy requirements, quantity limitations, formulary alternatives, and non-covered medication issues.
- Serve as a liaison between providers, nurses, pharmacists, insurance carriers, manufacturer representatives, and pharmacy staff to facilitate timely access to specialty medications and ensure continuity of care.
- Assist in identifying patients who may benefit from manufacturer copay assistance programs, patient assistance programs, grants, or alternate funding resources.
- Monitor turnaround time benchmarks and productivity metrics to ensure timely completion of authorization requests and reauthorizations.
- Communicate authorization determinations, coverage changes, and appeal outcomes to providers, pharmacy staff, and nursing in a timely and professional manner.
- Participate in payer audits, accreditation reviews, and internal quality assurance initiatives by maintaining accurate and compliant documentation.
- Ensure compliance with HIPAA, Medicare, Medicaid, commercial payer regulations, URAC and ACHC accreditation standards, organizational policies, and specialty pharmacy best practices.
- Identify trends related to payer denials, authorization delays, and documentation deficiencies and provide recommendations for process improvement.
- Analyze reports related to authorization volumes, approval rates, denial rates, appeal success rates, reimbursement outcomes, accounts receivable performance, and financial impact to support departmental and organizational goals.
- Maintain a high level of customer service while managing sensitive patient information and complex reimbursement issues in a fast-paced specialty pharmacy environment.
- Monitor pharmacy accounts receivable related to specialty medication claims, authorizations, and reimbursement activities. Investigate outstanding balances, payer underpayments, claim denials, payment variances, and reimbursement delays. Collaborate with billing, revenue cycle, pharmacy, providers, and payer representatives to resolve claim discrepancies, facilitate payment recovery, reduce aged receivables, and optimize reimbursement performance.
Knowledge:
- Strong knowledge of utilization review, prior authorization, reauthorization, and appeals processes for specialty medications.
- Strong understanding of specialty pharmacy reimbursement, claims adjudication, denial management, and revenue cycle processes.
- Knowledge of commercial insurance, Medicare, Medicaid, managed care organizations, pharmacy benefit managers (PBMs), and medical benefit coverage policies.
- Knowledge of specialty medication authorization, reauthorization, and appeals processes, including medical necessity reviews and payer-specific clinical criteria.
- Knowledge of medical terminology, pharmaceutical terminology, disease state management, and clinical documentation requirements.
- Knowledge of denial management processes, appeals strategies, reimbursement methodologies, and revenue cycle principles.
- Knowledge of electronic health records (EHRs), pharmacy management systems, payer portals, and other healthcare technology platforms used to support utilization review and reimbursement activities.
Skills:
- Proficiency in reviewing and interpreting clinical documentation, laboratory results, payer policies, and medical necessity criteria.
- Excellent verbal and written communication skills with the ability to effectively communicate with providers, pharmacists, nurses, payers, patients, and manufacturer representatives.
- Strong organizational and time management skills with the ability to prioritize multiple assignments and meet deadlines in a fast-paced environment.
- Demonstrated attention to detail and accuracy in reviewing clinical documentation, authorization submissions, and payer communications.
- Proficiency in electronic health records (EHR), pharmacy management systems, payer portals, and Microsoft Office applications, including Excel, Word, Outlook, and Teams.
Abilities:
- Ability to adapt to changing payer requirements, technology platforms, accreditation standards, and healthcare regulations.
- Ability to analyze coverage determinations, denial rationales, and reimbursement issues and develop effective resolution strategies.
- Ability to exercise sound judgment and critical thinking when evaluating payer requirements, authorization requests, and reimbursement challenges.
- Ability to navigate complex commercial, Medicare, Medicaid, and managed care insurance requirements.
- Ability to work independently while collaborating effectively within a multidisciplinary healthcare team.
Requirements
- High school diploma or GED
- 3-5 years of related experience
- All IHI employees are expected to enable multi-factor authentication via their personal smart phone/smart device in order to access IHI systems as a requirement of the role.
Benefits
IHI is a not-for-profit program based in Indianapolis and offers a competitive salary and benefit package.
IHI is the only ederally designated comprehensive hemophilia program in Indiana, and serves the entire state through services available in Indianapolis and at outreach clinics.
IHI is a leader in hemophilia care, education and clinical research and has a dedicated on-site multidisciplinary staff to ensure availability of a wide range of required services.
IHI participates in national and international clinical research, including new infusion products and therapies, investigation of long-term outcomes, and the impact of associated conditions. The IHTC research program provides patients access to new therapies, and an opportunity to improve care. Our center has more than 70 clinical research projects involving bleeding disorders, sickle cell disease, thrombosis and more.
The Indiana Hemophilia and Thrombosis Center is an Equal Opportunity Employer.