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Nursing Utilization Review Jobs in Indiana (NOW HIRING)

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Critical utilization management functions during the admission phase include admission review for ... Will be working closely with Summit Nursing Supervisors and admitting physicians for patient who ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Critical utilization management functions during the admission phase include admission review for ... Will be working closely with Summit Nursing Supervisors and admitting physicians for patient who ...

Riverview Health

Clinical Case Mgr

Noblesville, IN · On-site

Five (5) years' experience in utilization review and discharge planning. License/Certification Requirements * Minimim: Registered Nurse, Licensed Social Worker, Clinical Social Worker, or LMSW as ...

RIVERVIEW HOSPITAL

Clinical Case Mgr

Noblesville, IN · On-site

Five (5) years' experience in utilization review and discharge planning. License/Certification Requirements * Minimim: Registered Nurse, Licensed Social Worker, Clinical Social Worker, or LMSW as ...

TEEMA Group

RN Care Manager

Evansville, IN · On-site

$85K - $95K/yr

Perform utilization review (UR) and payer communication * Support hospital goals: reduce LOS, prevent readmissions, improve outcomes ✅ What You Bring: * Active RN license (Indiana or compact)

Riverview Health

Clinical Case Mgr

Noblesville, IN · On-site

Five (5) years' experience in utilization review and discharge planning. License/Certification Requirements * Minimim: Registered Nurse, Licensed Social Worker, Clinical Social Worker, or LMSW as ...

Deaconess

Clinical Denial Analyst (RN)

Evansville, IN · On-site

$28.71 - $40.19/hr

Minimum of two (2) years performing utilization review, charge audit, case management or similar ... Registered Nurse // HRS // Healthcare Resources // UM // Utilization Management // Case Management ...

EDGEWATER HEALTH

NURSE MANAGER

Gary, IN

Ensures standards for admission, utilization review, and concurrent review are followed. Staff Leadership and Development * Supervises nursing personnel and provides clinical guidance to residential ...

Edgewater Health

Ensures standards for admission, utilization review, and concurrent review are followed. Staff Leadership and Development Supervises nursing personnel and provides clinical guidance to residential ...

Edgewater Health

Nurse Manager

Gary, IN

Ensures standards for admission, utilization review, and concurrent review are followed. Staff Leadership and Development Supervises nursing personnel and provides clinical guidance to residential ...

Elevance Health

Clinical Review Nurse II (US)

Indianapolis, IN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Requires AS in nursing and minimum of 3 years of clinical experience; or any combination of ... Medical management or Utilization Review experience is preferred. For candidates working in person ...

Elevance Health

Clinical Review Nurse II (US)

Indianapolis, IN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Requires AS in nursing and minimum of 3 years of clinical experience; or any combination of ... Medical management or Utilization Review experience is preferred. For candidates working in person ...

UHS

UR Coordinator (PRN)

Kouts, IN · On-site

Experience in patient assessment, family motiviation, treatment planning and communication with external review organizations or comparable entities. • RN, LSW, LCSW license or equivalent. EEO ...

Elevance Health

Clinical Review Nurse II (US)

Indianapolis, IN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Requires AS in nursing and minimum of 3 years of clinical experience; or any combination of ... Medical management or Utilization Review experience is preferred. For candidates working in person ...

Elevance Health

Med Mgmt Nurse

Indianapolis, IN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Requires a minimum of associate's degree in nursing. * Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or ...

Elevance Health

Med Mgmt Nurse

Indianapolis, IN

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Requires a minimum of associate's degree in nursing. * Requires a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or ...

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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?

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.

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, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Management Representative I

Elevance Health

Indianapolis, IN • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 22 days ago

Elevance Health rating

7.7

Company rating: 7.7 out of 10

Based on 351 frontline employees who took The Breakroom Quiz

204th of 308 rated insurance

Job description

Anticipated End Date:

2026-08-21

Position Title:

Utilization Management Representative I

Job Description:

Utilization Management Representative I

Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.


The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review.

Hours: Training is conducted from 7:00 AM to 3:30 PM Mountain Time, with standard shift hours from 8:30 AM to 5:30 PM Mountain Time. Please adjust for your time zone. Candidates will be required to work rotating weekends and select holidays, and must be flexible and available to work overtime. Weekend shift hours may vary.

How you will make an impact:

  • Managing incoming calls or incoming post services claims work.

  • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.

  • Refers cases requiring clinical review to a Nurse reviewer.

  • Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.

  • Responds to telephone and written inquiries from clients, providers and in-house departments.

  • Conducts clinical screening process.

  • Authorizes initial set of sessions to provider.

  • Checks benefits for facility based treatment.

  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

  • Associates in this role are expected to have the ability to multi-task, including handling calls, texts, facsimiles, and electronic queues, while simultaneously taking notes and speaking to customers.

  • Additional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts.

  • Associates in this role will have a structured work schedule with occasional overtime or flexibility based on business needs, including the ability to work from the office as necessary.

  • Performs other duties as assigned.

Minimum Requirements:

  • Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Inbound call center experience strongly preferred.

  • Medical terminology training and experience in medical or insurance field strongly preferred.

  • For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level:

Non-Management Non-Exempt

Workshift:

Job Family:

CUS > Care Support

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.


Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.


How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.


Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.


NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.

What Elevance Health employees say

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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