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Utilization Management Jobs in Indiana (NOW HIRING)

Highmark Health

Senior Pharmacist - Strategy

Indianapolis, IN · On-site

$55.75 - $67/hr

Formulary & Utilization Management Strategy & Development: May lead Highmark's evidence-based medicine drug evaluation program supporting Highmark's formulary and utilization management (UM) and/or ...

Seven Healthcare

RN - Case Management

Fort Wayne, IN · On-site

$2.7K/wk

M-F Days, weekend rotation required Seven Healthcare are seeking an experienced RN - Case Manager specializing in Utilization Management for a travel assignment in Fort Wayne, IN. This exciting role ...

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Powers Health

Physician Advisor

Munster, IN

The Physician Advisor will provide clinical expertise to support utilization management (UM) and quality initiatives within the healthcare setting. Key responsibilities include conducting clinical ...

Powers Health

Physician Advisor

Hobart, IN

The Physician Advisor will provide clinical expertise to support utilization management (UM) and quality initiatives within the healthcare setting. Key responsibilities include conducting clinical ...

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All JobsUtilization Management JobsUtilization Management Jobs in Indiana

Utilization Management information

See Indiana salary details

$37.1K

$85.1K

$155.1K

How much do utilization management jobs pay per year?

As of Jun 29, 2026, the average yearly pay for utilization management 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 jobs pay 4000 a week without a degree?

Utilization Management roles typically require healthcare or insurance industry knowledge and often a relevant certification rather than a degree. High-paying jobs that can reach $4,000 a week without a degree include sales positions, real estate brokers, commercial pilots, or skilled trades like electricians and plumbers, especially with experience and certifications. These roles often involve commission, bonuses, or overtime to achieve such earnings.

What jobs pay $2000 a day?

Jobs that can pay $2000 a day typically include specialized roles such as senior management, high-level consultants, certain medical specialists, and experienced legal professionals. These positions often require advanced skills, extensive experience, and sometimes certifications, and they may involve freelance or contract work with high hourly or project-based rates.

What are the key skills and qualifications needed to thrive in the Utilization Management position, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is a Utilization Management job?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What is the least stressful healthcare job?

Utilization management roles are often considered less stressful compared to direct patient care jobs because they involve reviewing medical necessity and insurance claims rather than providing hands-on treatment. These positions typically have regular hours, less physical demand, and focus on administrative tasks, making them a lower-stress option within healthcare. However, stress levels can vary based on workplace environment and individual preferences.

What does utilization management do?

Utilization management is a healthcare job that involves reviewing and approving or denying medical services to ensure they are necessary and appropriate. It helps control healthcare costs and maintains quality by evaluating treatment plans, often using guidelines and data analysis. Professionals in this role typically work with insurance companies, healthcare providers, and use tools like medical records and clinical criteria.

What are the typical daily responsibilities of a Utilization Management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the most commonly searched types of Utilization Management jobs in Indiana? The most popular types of Utilization Management jobs in Indiana are:
What are popular job titles related to Utilization Management jobs in Indiana? For Utilization Management jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Indiana look for? The top searched job categories for Utilization Management jobs in Indiana are:
What cities in Indiana are hiring for Utilization Management jobs? Cities in Indiana with the most Utilization Management job openings:
Utilization Management jobs near you
Utilization Manage Nurse (BHS)

Utilization Manage Nurse (BHS)

Beacon Health System

Granger, IN • On-site

Full-time

Posted 6 days ago

Beacon Health System rating

6.6

Company rating: 6.6 out of 10

Based on 138 frontline employees who took The Breakroom Quiz

561st of 877 rated healthcare providers

Job description

Reports to the Manager. Serves as a liaison between hospitals, physicians, third-party payors and auditors to ensure information needs are met. Responsibilities include the review of medical records to determine the appropriateness and medical necessity of hospitalization. Coordinates and maintains the appeal process for denied hospitalizations. Maintains confidentiality regarding all information collected.
MISSION, VALUES and SERVICE GOALS
  • MISSION: We deliver outstanding care, inspire health, and connect with heart.
  • VALUES: Trust. Respect. Integrity. Compassion.
  • SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Maintains systems for monitoring patient admissions and extended stays for appropriateness and medical necessity by:
  • Reviewing patient admission clinical information using clinical criteria and guidelines available to assist the physician in the determination of medical necessity and/or appropriate admission status (inpatient or outpatient).
  • Communicating, in a timely manner, with third-party payors to justify admission or continued stay.
  • Reviewing extended stays prior to expiration of initially-assigned length of stay.
  • Referring questionable medical necessity or extended stays to the Manager/Director, treating Physician (or Medical Director) as appropriate.
  • Interacting with other Hospital departments in matters related to review decisions and fiscal communications.
  • Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or Therapists.
  • These functions apply to associates assigned to Epworth Center only:
  • Maintains system for monitoring and completing Medicare Certification/ Recertification for inpatient psychiatric services.
  • Submission of 1261A forms within 14 days of admission for each Medicaid Psychiatric admission.

Anticipates and reviews denials and facilitates the appeal process by:
  • Anticipating and reviewing denials by payors for lack of medical necessity, inadequate medical information or delay in discharge; also intervening by written appeal to avoid loss of revenue.
  • Arranging physician-to-physician clinical reviews with insurance company, Medical Director and Attending Physician.
  • Writing denial appeal letters on behalf of the patient and/or the Hospital, when appropriate, to avoid loss of revenue.
  • Coordinating with the Manager/Director (and other management as appropriate) to identify and correct weaknesses in the admission and patient care process that can mitigate future denials.
  • Issuing Notices of Non-coverage (insurance &/or Medicare) to patients as necessary.

Serves as a Memorial Hospital and Beacon Health System resource regarding reimbursement by:
  • Maintaining knowledge regarding current regulations (PRO, TJC, AHA, etc.) which impact utilization review activities.
  • Meeting with physicians, Hospital staff, review agencies, insurance companies and others (as relevant) in the assessment of utilization needs.
  • Educating patients and patients' families regarding Medicare regulations and issues, and notices of non-coverage when appropriate.
  • Identifying risk issues concurrently with clinical reviews to provide the Hospital management with valid information on potentially compensable events; also communicating with the Manager/Director and the Director, Risk Management.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:
  • Looking for opportunities to improve departmental operations, patient care delivery and utilization of acute healthcare resources; also striving for continuous quality improvement.
  • Staying current on trends related to medical necessity, DRG and Recovery Audit Contractor (RAC).
  • Completing other job-related assignments and special projects as directed.
ORGANIZATIONAL RESPONSIBILITIES
Associate complies with the following organizational requirements:
  • Attends and participates in department meetings and is accountable for all information shared.
  • Completes mandatory education, annual competencies and department specific education within established timeframes.
  • Completes annual employee health requirements within established timeframes.
  • Maintains license/certification, registration in good standing throughout fiscal year.
  • Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
  • Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
  • Adheres to regulatory agency requirements, survey process and compliance.
  • Complies with established organization and department policies.
  • Available to work overtime in addition to working additional or other shifts and schedules when required.

Education and Experience
  • The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a Nursing program. A valid and current Registered Nurse license in the state of Indiana is which the associate works is required. Two years of clinical experience is required. Two years of progressively responsible experience in a utilization review environment is preferred.

Knowledge & Skills
  • Requires fundamental knowledge of the revenue cycle process, which includes such things as patient access, utilization review, charge capture, HIM and patient accounting.
  • Requires the advanced analytical and critical thinking skills necessary to audit patient care data, associated patient care documentation and identify variances in standards of care.
  • Requires knowledge of rules and regulations pertaining to hospital reimbursement.
  • Requires familiarity with managed care principles and an understanding of post-acute continuum of care.
  • Requires the interpersonal skills necessary to maintain effective working relationships and interact effectively with staff, physicians, review agencies, insurance companies, patients and patients' families.
  • Requires the effective communication skills (both verbal and written) necessary to prepare documentation, write appeal letters and to provide education to staff and physicians regarding the revenue cycle process.
  • Demonstrates the ability to be self-motivated, detail oriented and make independent decisions. Also demonstrates the ability to respond quickly and appropriately to customer requests.
  • Demonstrates a working knowledge of the Hospital's computer systems (e.g., Star McKesson, Cerner Power Chart) and proficiency in computer skills (i.e., word processing, spreadsheets, utilizing the internet, etc.).

Working Conditions
  • Works in an office environment and patient care areas when making rounds to review medical records. Will travel between various Beacon facilities.
  • May have contact with patients and family members who may be under considerable stress.
  • May be exposed to bio-hazards.

Physical Demands
  • Requires the physical ability and stamina to perform the essential functions of the position.

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