Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Coordinate and support the hospital's Utilization Review and Case Management program to ensure appropriate level of care, efficient resource use, and timely discharge planning. * Review patient ...
Coordinate and support the hospital's Utilization Review and Case Management program to ensure appropriate level of care, efficient resource use, and timely discharge planning. * Review patient ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Prior utilization review, case management, or payer review experience preferred * Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines * Solid understanding of clinical care ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
$30.72/hr
Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
UTILIZATION REVIEW RN
Seymour, IN · On-site
$30.72/hr
Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...
Utilization Review Specialist
Lafayette, IN · On-site
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
Utilization Review Specialist
Lafayette, IN · On-site
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
... you'll contribute Utilization Review Specialist facilitates clinical reviews on all patient ... UR contacts external case managers/managed care organizations for certification of insurance ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
Minimum of 2 years of utilization review experience in a hospital setting required ... Minimum of 2 years of case management experience, including discharge planning in a hospital ...
... management, and retro-authorizations Research and responds provider inquires concerning ... utilization review and authorization. Operates within program requirements in accordance with CMS ...
... management, and retro-authorizations Research and responds provider inquires concerning ... utilization review and authorization. Operates within program requirements in accordance with CMS ...
RN Case Manager
Evansville, IN · On-site
$83K - $93K/yr
RN Case Manager 📍 Location: Evansville, IN 💼 Schedule: Full-Time | Monday-Friday ⏰ Hours ... Conduct utilization review (UR) and ensure appropriate level of care * Collaborate with physicians ...
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RN Case Manager
Evansville, IN · On-site
$83K - $93K/yr
RN Case Manager 📍 Location: Evansville, IN 💼 Schedule: Full-Time | Monday-Friday ⏰ Hours ... Conduct utilization review (UR) and ensure appropriate level of care * Collaborate with physicians ...
Utilization Review Case Manager information
See Indiana salary details
$15.78 - $19.55
3% of jobs
$19.55 - $23.31
1% of jobs
$23.31 - $27.07
6% of jobs
$28.89 is the 25th percentile. Wages below this are outliers.
$27.07 - $30.84
30% of jobs
The median wage is $32.19 / hr.
$30.84 - $34.60
26% of jobs
$36.04 is the 75th percentile. Wages above this are outliers.
$34.60 - $38.37
22% of jobs
$38.37 - $42.13
3% of jobs
$42.13 - $45.89
0% of jobs
$45.89 - $49.66
5% of jobs
$49.66 - $53.42
2% of jobs
$53.42 - $57.19
1% of jobs
$15
$34
$57
How much do utilization review case manager jobs pay per hour?
As of Jun 12, 2026, the average hourly pay for utilization review case manager in Indiana is $34.72, according to ZipRecruiter salary data. Most workers in this role earn between $28.12 and $36.59 per hour, depending on experience, location, and employer.
What are some common challenges Utilization Review Case Managers face when coordinating care across multiple departments?
Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.
What is a Utilization Review Case Manager?
A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.
What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?
| Aspect | Utilization Review Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license or relevant healthcare certification | Registered Nurse (RN) license is required |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinic, insurance review departments |
| Primary Focus | Reviewing medical necessity, coordinating care, managing cases | Assessing medical records, clinical review, patient care evaluation |
Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.
What are the key skills and qualifications needed to thrive as a Utilization Review Case Manager, and why are they important?
To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Indiana? For Utilization Review Case Manager jobs in Indiana, the most frequently searched job titles are:
- Utilization Management
- Manager Utilization Management
- Temporary Admission Discharge Nurse
- Cvs Health Utilization Management
- Registered Nurse Utilization Review
- Interqual Training Operation
- No Experience Utilization Review Nurse
- Remote Utilization Management
- Telecommute Medical Record Reviewer
- Commission Cvs Health Utilization Management
What job categories do people searching Utilization Review Case Manager jobs in Indiana look for? The top searched job categories for Utilization Review Case Manager jobs in Indiana are:
- Foster Care Case Manager
- Lpn Utilization Review Work From Home
- Weekend Utilization Review
- Director Optum Utilization Review
- Utilization Review Manager
- Remote Aetna Utilization Review Nurse
- Registered Nurse Reviewer
- Volunteer Aetna Utilization Review Nurse
- Registered Nurse Case Review
- Nurse Practitioner Utilization Review
What cities in Indiana are hiring for Utilization Review Case Manager jobs? Cities in Indiana with the most Utilization Review Case Manager job openings:
Part-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 24 days ago
Trinity Health rating
6.5
Based on 349 frontline employees who took The Breakroom Quiz
591st of 871 rated healthcare providers
Job description
Employment Type:Part timeShift:Rotating ShiftDescription:This is a remote position but will need onsite training in Mishawaka Indiana.
Shift: PRN/Days - 8 hr shift
Considering local candidates only!!!
Shift: PRN/Days - 8 hr shift
Considering local candidates only!!!
Why Choose Saint Joseph Health System?
At Saint Joseph Health System, our values guide every decision we make. Even when challenges arise, we remain committed to our mission: caring for every person who needs us. We invest in our people, our technology, and our capabilities so we can continue delivering exceptional, compassionate care to our communities.
Tuition reimbursement for all full-time and part-time colleagues starting on day one
Comprehensive benefits beginning day one (Medical, Dental, Vision, PTO, Life Insurance, STD/LTD, and more)
Retirement savings plan with employer match
Generous paid time off program plus 7 paid holidays
No mandatory overtime
Employee referral incentive program
Access to state-of-the-art equipment, unlimited CEUs, and a supportive team-focused work environment
- Conduct clinical reviews of patient records to evaluate medical necessity, appropriateness of admission, treatment, and length of stay across all payor types
- Apply standardized criteria, regulatory guidelines, and insurance requirements to support reimbursement and compliance
- Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource utilization and care planning
- Review admissions and ongoing patient cases; recommend or escalate cases that do not meet criteria to leadership or the Utilization Review Committee
- Facilitate timely discharges, transfers, and recertifications when level of care is no longer appropriate
- Partner with Medicare, Medicaid, and private insurers to ensure accurate documentation and reimbursement processes
- Respond to denials and authorization changes by reviewing medical records and communicating outcomes to care teams and patients
- Identify trends and utilization concerns; contribute to performance improvement and quality initiatives
- Maintain accurate records, compile reports, and support utilization review program operations
- Provide education to clinical staff on documentation requirements, coverage guidelines, and utilization processes
- Support compliance with all regulatory, accreditation, and organizational standards
- Participate in committee meetings and assist in development of utilization review plans and processes
- Graduate of an accredited Registered Nurse (RN) program; Bachelor's Degree in Nursing preferred
- Active RN license (state-specific requirement applies)
- Minimum of 2 years of acute care nursing experience
- Prior utilization review, case management, or payer review experience preferred
- Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines
- Solid understanding of clinical care practices, diagnoses, treatment modalities, and hospital operations
- Excellent communication skills with the ability to collaborate effectively across teams
- Strong analytical and critical thinking skills to assess clinical appropriateness and compliance
- Proficiency in computer systems and Microsoft Office applications
- Ability to manage multiple priorities in a fast-paced healthcare environment
- Flexibility to adapt to changing schedules, workflows, and departmental needs
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
What Trinity Health employees say
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About Trinity Health
Sourced by ZipRecruiter
Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Livonia, MI, US