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Utilization Management Nurse Jobs in Indiana (NOW HIRING)

SIHO Insurance Services, Inc.

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Utilization Management Nurse

Columbus, IN · On-site

Utilization Management Nurse Reports To: Manager of Utilization Management Brief Description of Duties: This position is reserved for a licensed Registered Nurse who will perform the Utilization ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Reports to the Manager, Utilization Management Department. Serves as a liaison between Memorial ... This position will be deployed from the Summit Center, working closely with nursing supervisors ...

Elevance Health

Utilization Management Rep I

Indianapolis, IN · On-site

$15.25 - $20.75/hr

Utilization Management Rep I Utilization Management Representative I Location: Virtual: This role ... Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ...

Veterans Health Administration

Nurse

Marion, IN · On-site +1

$68K - $145K/yr

Summary The Revenue Utilization Review (RUR) nurse is under the supervision of the Nurse Manager and ANM. The RUR nurse is an active member of the revenue cycle program and functions within the scope ...

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 ...

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All JobsUtilization Management Nurse JobsUtilization Management Nurse Jobs in Indiana

Utilization Management Nurse information

See Indiana salary details

$37.1K

$85.1K

$155.1K

How much do utilization management nurse jobs pay per year?

As of Jul 27, 2026, the average yearly pay for utilization management nurse in Indiana is $85,148.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,400.00 and $99,400.00 per year, depending on experience, location, and employer.

What are some common challenges a Utilization Management Nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

What are the key skills and qualifications needed to thrive as a Utilization Management Nurse, and why are they important?

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What does a utilization management nurse do?

A utilization management nurse reviews medical records and treatment plans to determine if healthcare services meet insurance or clinical guidelines for necessity and appropriateness. They collaborate with healthcare providers and insurance companies to approve, modify, or deny coverage, often using electronic health records and adhering to regulatory standards. Certification in case management or utilization review is common in this role.

What is a Utilization Management Nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

How to make an extra 2000 a month as a nurse?

Utilization Management Nurses can increase their income by taking on additional part-time or per diem shifts, especially in high-demand settings. Developing specialized skills or certifications, such as case management or health informatics, can also qualify them for higher-paying roles or consulting opportunities outside regular hours.

What is the difference between Utilization Management Nurse vs Case Manager?

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

How to make 150,000 as a nurse?

A Utilization Management Nurse can earn $150,000 by gaining extensive experience, obtaining advanced certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or specialty healthcare organizations. Developing strong analytical skills and understanding healthcare policies can also enhance earning potential, often requiring a master's degree or specialized training. Salary varies based on location, employer, and level of expertise.

What Does a Utilization Management Nurse Do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

How to get into utilization management as a nurse?

To become a utilization management nurse, candidates typically need a registered nurse (RN) license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can improve job prospects, and strong knowledge of healthcare policies and documentation is essential.
More about Utilization Management Nurse jobs
What are the most commonly searched types of Utilization Management Nurse jobs in Indiana? The most popular types of Utilization Management Nurse jobs in Indiana are:
What are popular job titles related to Utilization Management Nurse jobs in Indiana? For Utilization Management Nurse jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Utilization Management Nurse jobs in Indiana look for? The top searched job categories for Utilization Management Nurse jobs in Indiana are:
What cities in Indiana are hiring for Utilization Management Nurse jobs? Cities in Indiana with the most Utilization Management Nurse job openings:
What are popular job titles related to Utilization Management Nurse jobs in IN? For Utilization Management Nurse jobs in IN, the most frequently searched job titles are:
Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Indiana as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $85,148 per year, or $40.9 per hour.
Utilization Management Nurse

Utilization Management Nurse

SIHO Insurance Services

Columbus, IN

Full-time

Posted 29 days ago

Job description

Job Title:  Utilization Management Nurse
Reports To: Manager of Utilization Management
Employment Type:  Full-Time, Exempt 

Brief Description of Duties:     
This position is reserved for a licensed Registered Nurse who will perform the Utilization Management (UM) services for SIHO (and affiliated business lines’) members. This individual’s primary role is to ensure that health care services are administered with quality, cost effectiveness, and compliance to plan guidelines are maintained. By performing review of services prospectively, retrospectively, and throughout the episode of care, the UM nurse will make coverage determinations influencing how services are allocated to SIHO’s various member populations.  A candidate’s ability to perform quality reviews within strict efficiency standards is required for this position.  Key responsibilities are as follows: 
- Pre-service, concurrent, and post-service review of necessity of health care services utilizing enrollee medical records and established guidelines set by SIHO and/or state and federal (CMS) guidelines
- Interaction with the member, health care provider, and/or other care team members to complete reviews in most time-efficient manner
- Interaction with the SIHO Medical Director as needed to ensure proper medical necessity decisions are made in a timely manner
- Appropriate documentation of the entire review process utilizing the established documentation system and desk procedures to guarantee accurate reporting metrics and data integrity
- Complete case review and elevation to determinations that are rendered within the contractual and regulatory turnaround times established by SIHO and CMS
- Assist to resolve problems and provide guidance to members of the team and cohorts
-Interpret and abide by organizational policies and procedures; review work regularly to ensure that policies and guidelines are appropriately applied
-Act as a clinical resource to the department and other organization members for services pertaining to medical management, utilization review, and medical necessity
- Act and perform within the scope of professional nursing practice; is responsible in supporting and participating in department strategies and efforts focused on quality improvement
- Responsible for the early identification and assessment of members for inclusion in disease management or care management programs
- Assist in the identification and reporting of Potential Quality of Care concerns and Fraud, Waste and Abuse incidents
- Work as an interdisciplinary team member within Medical Management for all lines of business and commercial group plans 

Minimum Skills Requirement: 
- Registered Nurse with current, unrestricted license in primary state of employment (position may require additional licensing in other states as necessary)Previous UM or Health Plan experience highly preferred
- Desire to work in a fast-paced environment with focus on efficiency while maintaining quality
- Self-directed organization and prioritization skills, and independent time management skills required
- Sound clinical background with experience in the clinical field
- Excellent verbal and written communication skills
- Microsoft Office Experience: Outlook, Word, Excel

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.