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Medical Director Utilization Management Jobs in Indiana

SIHO Insurance Services, Inc.

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Utilization Management Nurse

Columbus, IN · On-site

Interaction with the SIHO Medical Director or external Medical Reviewers as needed to ensure proper ... management, utilization review, and medical necessity * Act and perform within the scope of ...

Elevance Health

Medical Director

Indianapolis, IN

Medical Director Location: This role enables associates to work virtually full-time, with the ... Utilization Management experience is a plus. * Ability to meet necessary internet speed ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Reports to the Manager, Utilization Management Department. Serves as a liaison between Memorial ... Referring questionable medical necessity or extended stays to the Manager/Director, treating ...

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All JobsMedical Utilization Management JobsMedical Director Utilization Management JobsMedical Director Utilization Management Jobs in Indiana

Medical Director Utilization Management information

See Indiana salary details

$12.4K

$221.1K

$339.7K

How much do medical director utilization management jobs pay per year?

As of Jul 27, 2026, the average yearly pay for medical director utilization management in Indiana is $221,113.00, according to ZipRecruiter salary data. Most workers in this role earn between $188,400.00 and $270,700.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Medical Director Utilization Management, and why are they important?

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a Medical Director in Utilization Management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is a Medical Director Utilization Management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

What are popular job titles related to Medical Director Utilization Management jobs in Indiana? For Medical Director Utilization Management jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Medical Director Utilization Management jobs in Indiana look for? The top searched job categories for Medical Director Utilization Management jobs in Indiana are:
What cities in Indiana are hiring for Medical Director Utilization Management jobs? Cities in Indiana with the most Medical Director Utilization Management job openings:
Medical Director Utilization Management jobs near you
Infographic showing various Medical Director Utilization Management job openings in Indiana as of July 2026, with employment types broken down into 6% As Needed, 88% Full Time, and 6% Part Time. Highlights an 94% In-person, and 6% Hybrid job distribution, with an average salary of $221,113 per year, or $106.3 per hour.

Utilization Management Nurse

SIHO HOLDING INC

Columbus, IN • On-site

Other

Posted yesterday

Job description

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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