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Utilization Care Manager Jobs in Indiana (NOW HIRING)

Franciscan Health

RN Case Manager

Michigan City, IN · On-site

... Manager II is critical for working with assigned patients, including assessing, facilitating ... utilization, care planning quality, and facilitates discharge planning on admission and concurrent ...

Franciscan Health

RN Case Manager

Michigan City, IN · On-site

... Manager II is critical for working with assigned patients, including assessing, facilitating ... utilization, care planning quality, and facilitates discharge planning on admission and concurrent ...

TEEMA Group

RN Care Manager

Evansville, IN · On-site

$85K - $95K/yr

RN Care Manager - NO Weekends | M-F Schedule | Evansville, IN 📍 Evansville, IN | Full-Time | Day ... Perform utilization review (UR) and payer communication * Support hospital goals: reduce LOS ...

TEEMA Group

RN Care Manager

Evansville, IN · On-site

$85K - $95K/yr

Participate actively in team meetings, quality improvement projects, and utilization review ... Familiarity with managed care environments, quality metrics, and cost-effective care models.

TEEMA Group

RN Care Manager

Evansville, IN · On-site

$85K - $95K/yr

Participate actively in team meetings, quality improvement projects, and utilization review ... Familiarity with managed care environments, quality metrics, and cost-effective care models.

Elevance Health

Nurse Case Manager II

Indianapolis, IN · On-site

$79K - $124K/yr

Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any ...

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Utilization Care Manager information

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What are popular job titles related to Utilization Care Manager jobs in Indiana? For Utilization Care Manager jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Utilization Care Manager jobs in Indiana look for? The top searched job categories for Utilization Care Manager jobs in Indiana are:
What cities in Indiana are hiring for Utilization Care Manager jobs? Cities in Indiana with the most Utilization Care Manager job openings:
Utilization Care Manager jobs near you

Inpatient Care Manager II 1.0 D

Franciscan Health

Indianapolis, IN • On-site

$109K - $111K/yr

Full-time

Posted 12 days ago

Franciscan Health rating

6.8

Company rating: 6.8 out of 10

Based on 268 frontline employees who took The Breakroom Quiz

453rd of 887 rated healthcare providers

Job description

Franciscan Health Indianapolis Campus
8111 S Emerson Ave Indianapolis, Indiana 46237
The Inpatient Care Manager II is critical for working with assigned patients, including assessing, facilitating, planning, and advocating health needs on an individual basis. In this role you will perform admission screening for all patients in a bed for medical necessity, reviews for appropriateness of setting, utilization, care planning quality, and facilitates discharge planning on admission and concurrent basis.
WHO WE ARE
With 11 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.
WHAT YOU CAN EXPECT
  • Maintain accurate, concise and timely documentation in EPIC and DOC flowsheets for discharge planning and payer authorization.
  • Act as liaison and coordinates with hospital multidisciplinary team, post-discharge providers and patient/family with the transition of care.
  • Comply with all accrediting bodies, governmental agencies, and third-party payer requirements related to discharge planning and mandated reporting.
  • Collaborate with the care team (nursing, provider, social worker, ancillary team members) to individualize treatment plans to address any patient care needs in order to achieve defined goals for improved patient outcomes.
  • Complete patient assessment to develop discharge plans, identifying the post-discharge needs of the patient and target appropriate resources for foll-up care, in collaboration with the patient, family and multidisciplinary care team to make the transition upon discharge seamless as possible for patients' continuum of care, minimizing risk for readmission. Integrating insurance, financial resources, clinical picture, functional capacity, availability of resources to assure a safe appropriate discharge.

Qualifications
  • Required Associate's Degree Nursing
  • Preferred Bachelor's Degree Nursing
  • 2 years Case Management Preferred
  • 5 years Nursing/Patient Care Preferred
  • Registered Nurse (RN) - State Licensing Board

TRAVEL IS REQUIRED:
EQUAL OPPORTUNITY EMPLOYER
It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.
Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.
Franciscan Alliance is committed to equal employment opportunity.
Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

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