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Nursing Utilization Review Jobs in Indiana (NOW HIRING)

Elevance Health

Med Mgmt Nurse

Indianapolis, IN · On-site

$44.56 - $85.11/hr

Minimum of an associate's degree in nursing. * Minimum of 4 years of care management or case management experience and minimum of 2 years of clinical, utilization review, or managed care experience ...

Interim HealthCare

RN Case Manager

Bloomington, IN · On-site

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...

Salo, Inc Career Site

RN Case Manager

Bloomington, IN · On-site

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...

Interim Health

RN Case Manager

Bloomington, IN · On-site

One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...

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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.

Licensed Practical Nurse (LPN)

Pediatric Plus Home Healthcare Services LLC

Charlestown, IN • On-site

$23.75 - $32.25/hr

Full-time

Re-posted 9 days ago

Job description

SUMMARY:

Provides skilled professional nursing services to pediatric and young adult patients in their home setting.

DUTIES AND RESPONSIBILITIES:

  • Follows nursing policies and procedures per agency standards.

  • Demonstrates a thorough understanding of state & HIPPA regulations.

  • Assesses patients according to their plan of care.

  • Follows plan of care according to physician orders.

  • Manages care of seriously ill, long-term, disabled, and terminally ill patients.

  • Evaluates, patient’s treatment/care plans; coordinates interdisciplinary care.

  • Obtains required physician orders for all care provided from a clinical supervisor.

  • Provides ongoing assessment of the patient and patient’s equipment needs.

  • Initiate preventative and rehabilitative nursing procedures.

  • Educates and instructs the patient and patient’s family as required; counsel patient and family in meeting patient’s needs and goals.

  • Notifies the clinical supervisor and family of significant changes in the patient’s condition in a timely manner.

  • Prepares timely, legible, and complete documentation of all care, interventions, and care coordination as provided by law, regulation, and established policy; returns documentation to office/department according to established policy.

  • Demonstrates an awareness of and sensitivity to patient/family rights.

  • Applies safety principles as identified by established policy.

  • Participates in quality improvement and utilization review activities.

  • Participates in the orientation and training of new staff.

  • Participates in continuing education to continually improve skills and abilities and stay abreast of current technologies/practices.

  • Participates in establishing priorities, and implementing and evaluating quality improvement efforts utilizing Quality Assurance & Performance Improvement. (QAPI)

  • Exhibits a high degree of courtesy, tact, and poise when interacting with patients, families, and other healthcare professionals.

  • Performs other related duties as assigned by management.

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