Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource utilization and care planning * Review admissions and ongoing patient cases; recommend or ...
Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource utilization and care planning * Review admissions and ongoing patient cases; recommend or ...
Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource utilization and care planning * Review admissions and ongoing patient cases; recommend or ...
Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource utilization and care planning * Review admissions and ongoing patient cases; recommend or ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... Utilization Review and Medical Necessity * Concurrent Review and Length of Stay Management
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
Graduate of accredited school of nursing (BSN Preferred) Preferred: Bachelors Degree in Nursing ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... 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 ...
... 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 ...
Utilization Review Manager - SUD | Anabranch Recovery Center | Terre Haute, Indiana About the Job ... Graduation from an accredited school of nursing OR a Bachelor's degree in social work, behavioral ...
Utilization Review Manager - SUD | Anabranch Recovery Center | Terre Haute, Indiana About the Job ... Graduation from an accredited school of nursing OR a Bachelor's degree in social work, behavioral ...
... setting reviews to ensure compliance with applicable criteria, medical policy, and member ... AS/BS in Nursing or combination of education / experience * 2 years of experience in an acute care ...
... setting reviews to ensure compliance with applicable criteria, medical policy, and member ... AS/BS in Nursing or combination of education / experience * 2 years of experience in an acute care ...
Utilization Review RN
$30 - $34/hr
Expected to review 20 cases a day with a 95% accuracy rate. Responsible for collaborating with ... Must have clear and active RN license in the state of IN * 2 years of experience in a acute care ...
Utilization Review RN
$30 - $34/hr
Expected to review 20 cases a day with a 95% accuracy rate. Responsible for collaborating with ... Must have clear and active RN license in the state of IN * 2 years of experience in a acute care ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
Quick apply
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work ...
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work ...
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
New
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
New
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
New
... thorough review of the total resources available to patient pre and post-discharge from ... Bachelor's degree in related field with 3-5 years' experience * LPN or RN experience preferred ...
New
Director of Assessment
Indianapolis, IN · On-site
$65K - $90K/yr
Collaborate with Medical Staff, Nursing, Utilization Review, and Business Office teams * Monitor key performance indicators including response times, conversion rates, and census * Drive census ...
Director of Assessment
Indianapolis, IN · On-site
$65K - $90K/yr
Collaborate with Medical Staff, Nursing, Utilization Review, and Business Office teams * Monitor key performance indicators including response times, conversion rates, and census * Drive census ...
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type ... review, and medical necessity - Act and perform within the scope of professional nursing practice ...
Quick apply
Utilization Management Nurse
Columbus, IN · On-site
Utilization Management Nurse Reports To: Manager of Utilization Management Employment Type ... review, and medical necessity - Act and perform within the scope of professional nursing practice ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Representative I Utilization Management Representative I Location : This ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I Utilization Management RepresentativeI Location: Virtual: This role ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Utilization Management Rep I Utilization Management RepresentativeI Location: Virtual: This role ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...
Nursing Utilization Review information
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 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 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?
| Aspect | Nursing Utilization Review | Nursing Case Management |
|---|---|---|
| Primary Focus | Assessing medical necessity and appropriateness of care for insurance or healthcare providers | Coordinating patient care plans and ensuring optimal health outcomes |
| Work Environment | Insurance companies, healthcare facilities, utilization review organizations | Hospitals, clinics, community health settings |
| Credentials | RN license, often with certifications in utilization review or case management | RN 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.
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:
- Night Utilization Review Nurse
- Remote Utilization Management Nurse
- Remote Admissions Nurse
- Remote Utilization Review Nurse
- Quality Review Nurse Remote
- No Experience Utilization Review Nurse
- No Experience Utilization Management Nurse
- No Experience Hedis Review Nurse
- Remote Utilization Review Rn
- Flex Schedule Remote Utilization Review Nurse
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:
- Optum Utilization Review Nurse
- Per Diem Optum Utilization Review
- Medical Claims Review Nurse
- Nurse Practitioner Utilization Review
- Remote Aetna Utilization Review Nurse
- Therapy Utilization Review
- Utilization Review Nurse Compact License
- Lpn Utilization Review Nurse
- Volunteer Aetna Utilization Review Nurse
- Remote Utilization Review Nurse Practitioner
What cities in Indiana are hiring for Nursing Utilization Review jobs? Cities in Indiana with the most Nursing Utilization Review job openings:
Part-time
Medical, Dental, Vision, Life, Retirement, PTO
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Trinity Health rating
6.6
Based on 354 frontline employees who took The Breakroom Quiz
570th of 887 rated healthcare providers
Job description
Employment Type:Part timeShift:Rotating ShiftDescription:This is a remote position but will need onsite training in Mishawaka Indiana.
Shift: PRN/Days - 8 hr shift
Considering local candidates only!!!
Shift: PRN/Days - 8 hr shift
Considering local candidates only!!!
Why Choose Saint Joseph Health System?
At Saint Joseph Health System, our values guide every decision we make. Even when challenges arise, we remain committed to our mission: caring for every person who needs us. We invest in our people, our technology, and our capabilities so we can continue delivering exceptional, compassionate care to our communities.
Tuition reimbursement for all full-time and part-time colleagues starting on day one
Comprehensive benefits beginning day one (Medical, Dental, Vision, PTO, Life Insurance, STD/LTD, and more)
Retirement savings plan with employer match
Generous paid time off program plus 7 paid holidays
No mandatory overtime
Employee referral incentive program
Access to state-of-the-art equipment, unlimited CEUs, and a supportive team-focused work environment
- Conduct clinical reviews of patient records to evaluate medical necessity, appropriateness of admission, treatment, and length of stay across all payor types
- Apply standardized criteria, regulatory guidelines, and insurance requirements to support reimbursement and compliance
- Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource utilization and care planning
- Review admissions and ongoing patient cases; recommend or escalate cases that do not meet criteria to leadership or the Utilization Review Committee
- Facilitate timely discharges, transfers, and recertifications when level of care is no longer appropriate
- Partner with Medicare, Medicaid, and private insurers to ensure accurate documentation and reimbursement processes
- Respond to denials and authorization changes by reviewing medical records and communicating outcomes to care teams and patients
- Identify trends and utilization concerns; contribute to performance improvement and quality initiatives
- Maintain accurate records, compile reports, and support utilization review program operations
- Provide education to clinical staff on documentation requirements, coverage guidelines, and utilization processes
- Support compliance with all regulatory, accreditation, and organizational standards
- Participate in committee meetings and assist in development of utilization review plans and processes
- Graduate of an accredited Registered Nurse (RN) program; Bachelor's Degree in Nursing preferred
- Active RN license (state-specific requirement applies)
- Minimum of 2 years of acute care nursing experience
- Prior utilization review, case management, or payer review experience preferred
- Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines
- Solid understanding of clinical care practices, diagnoses, treatment modalities, and hospital operations
- Excellent communication skills with the ability to collaborate effectively across teams
- Strong analytical and critical thinking skills to assess clinical appropriateness and compliance
- Proficiency in computer systems and Microsoft Office applications
- Ability to manage multiple priorities in a fast-paced healthcare environment
- Flexibility to adapt to changing schedules, workflows, and departmental needs
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
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About Trinity Health
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Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Livonia, MI, US