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Nursing Utilization Review Jobs in Indiana (NOW HIRING)

Ascension

Registered Nurse Utilization Review

Carmel, IN · On-site +1

$50 - $52/hr

Bachelors in Nursing * Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care * Utilization Review OR Case Management experience required * Must live locally ...

Socket.dev

Utilization Review Specialist

Indianapolis, IN · On-site

$60 - $80/hr

The Utilization Review Specialist serves as a key resource in minimizing prescription delays ... Collaborate with prescribers, nurses, pharmacists, and clinic staff to obtain missing clinical ...

New

UHS

MGR - UTILIZATION REVIEW / MGMT

Bloomington, IN · On-site

... oversees utilization management including, but not limited to: utilization review, case ... Must have Registered Nurse license or Master's Degree. Experience: 5-7 yrs acute inpatient ...

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Nursing Utilization Review information

What is nursing utilization review?

Nursing Utilization Review is a process where nurses evaluate the necessity, efficiency, and appropriateness of healthcare services provided to patients. These nurses review medical records, treatment plans, and patient progress to ensure that care meets established guidelines and is cost-effective. They play a key role in helping healthcare organizations maintain quality care while controlling costs and ensuring regulatory compliance. Utilization review nurses often work for hospitals, insurance companies, or government agencies.

What are the key skills and qualifications needed to thrive as a nursing utilization review nurse?

To thrive as a Nursing Utilization Review Nurse, you need strong clinical knowledge, critical thinking, and a current RN license, often complemented by experience in case management or utilization review. Familiarity with healthcare coding systems (ICD-10, CPT), utilization management software, and regulatory compliance tools is typical. Excellent communication, attention to detail, and negotiation skills make someone stand out in this position. These skills ensure accurate assessment of medical necessity, optimize resource use, and support patient care quality within regulatory guidelines.

What are some common challenges faced by nurses working in utilization review, and how can they be managed?

Nurses in utilization review often face challenges such as balancing the need for cost-effective care with advocating for patients' clinical needs and navigating complex insurance guidelines. They must critically review medical records while ensuring compliance with evolving regulatory standards. Effective time management and strong communication skills are essential for liaising between healthcare providers, insurance companies, and patients. Ongoing education and collaboration with interdisciplinary teams can help address these challenges and ensure high-quality, patient-centered care.

What is the difference between Nursing Utilization Review vs Nursing Case Management?

AspectNursing Utilization ReviewNursing Case Management
Primary FocusAssessing medical necessity and appropriateness of care for insurance or healthcare providersCoordinating patient care plans and ensuring optimal health outcomes
Work EnvironmentInsurance companies, healthcare facilities, utilization review organizationsHospitals, clinics, community health settings
CredentialsRN license, often with certifications in utilization review or case managementRN license, case management certification often preferred

While both roles involve nursing expertise, Nursing Utilization Review primarily focuses on evaluating the necessity of care for insurance purposes, whereas Nursing Case Management emphasizes coordinating patient care to improve health outcomes. Both roles require RN licensure and related certifications, but their daily tasks and work environments differ.

How to get into nursing utilization review as a nurse?

To become a nursing utilization review nurse, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can improve job prospects, and familiarity with healthcare management software is often required.

What does a nursing utilization review nurse do?

A nursing utilization review nurse evaluates patient records to determine the necessity, appropriateness, and efficiency of healthcare services. They review medical documentation, collaborate with healthcare providers, and ensure compliance with insurance and regulatory guidelines, often using electronic health records and clinical guidelines. Certification in case management or utilization review is commonly required.

What are popular job titles related to Nursing Utilization Review jobs in Indiana?

For Nursing Utilization Review jobs in Indiana, the most frequently searched job titles are:

What job categories do people searching Nursing Utilization Review jobs in Indiana look for?

The top searched job categories for Nursing Utilization Review jobs in Indiana are:

What cities in Indiana are hiring for Nursing Utilization Review jobs?

Cities in Indiana with the most Nursing Utilization Review job openings:

Nursing Utilization Review jobs near you
Infographic showing various Nursing Utilization Review job openings in Indiana as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, 2% Contract, and 1% Nights. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution.

Registered Nurse Utilization Review

Ascension

Carmel, IN • On-site, Remote

$50 - $52/hr

Full-time, Per diem

Medical, PTO

Re-posted 12 days ago

Ascension Healthcare rating

7.0

Company rating: 7.0 out of 10

Based on 1,046 frontline employees who took The Breakroom Quiz

421st of 898 rated healthcare providers

Job description

Your future role at a glance

Location: Indianapolis, IN

Facility: Ascension St. Vincent

Department/Specialty: Utilization Management

Schedule: PRN. 0800-1700 ET, need coverage for Monday-Friday, weekends and holidays. Must be able to commit to training requirements, which is Monday-Friday for 8 hours/day for 6 weeks.

Salary range: $50/hour-$52/hour

How you'll make an impact in this role
  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
What minimum qualifications you'll need

Licensure / Certification / Registration:

  • Registered Nurse credentialed from the Indiana Board of Nursing obtained prior to hire date or job transfer date required.

Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire required.
What additional requirements you'll need
  • Active Indiana or compact RN License
  • Bachelors in Nursing
  • Minimum of 3 years hospital based bedside nursing experience in Med/Surg, ER, or critical care
  • Utilization Review OR Case Management experience required
  • Must live locally in Indiana
Life at Ascension: Where purpose meets opportunity

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.

Equal employment opportunity employer

Equal employment opportunity employer

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

Fraud prevention notice

Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

E-Verify statement

Employer participates in the Electronic Employment Verification Program. Please click here for more information.

Benefits

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.

Employment Type: OTHER

What Ascension Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Ascension

Sourced by ZipRecruiter

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Industry

Health care and social assistance and outpatient health care

Company size

10,000+ Employees

Headquarters location

St. Louis, MO, US

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