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Utilization Review Np Jobs in Indiana (NOW HIRING)

UHS

NURSE PRACTITIONER

Bloomington, IN · On-site

The psychiatric nurse practitioner may also complete Utilization Review calls on behalf of physicians and provide services at the partial hospitalization program. Bloomington Meadows Hospital is a 78 ...

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Utilization Review Np information

What are some common challenges Utilization Review Nurse Practitioners face when collaborating with healthcare providers and insurance companies?

Utilization Review Nurse Practitioners often navigate the challenge of balancing patient advocacy with payer requirements. They must effectively communicate clinical justifications to both healthcare providers and insurance representatives, sometimes mediating disagreements over the necessity of certain treatments or hospital stays. Staying up-to-date with ever-changing insurance guidelines and ensuring timely documentation can also be demanding, but strong organizational and interpersonal skills help facilitate smooth collaboration and successful patient outcomes.

What does a Utilization Review NP do?

A Utilization Review Nurse Practitioner (NP) evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance coverage to ensure that care meets established guidelines and regulatory requirements. Utilization Review NPs help coordinate care, prevent unnecessary procedures, and support cost-effective healthcare delivery while ensuring patient safety and quality outcomes.

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

To thrive as a Utilization Review Nurse Practitioner (NP), you need expert clinical judgment, a strong understanding of healthcare regulations, and advanced assessment skills, typically supported by an active NP license and clinical experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare and Medicaid are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for effective case evaluations and collaboration with providers. These competencies ensure accurate, efficient reviews that support quality care, compliance, and cost-effective treatment decisions.

What is the difference between Utilization Review Np vs Utilization Review Nurse?

AspectUtilization Review NpUtilization Review Nurse
CredentialsMaster's degree in Nursing, Nurse Practitioner certification, state licensureRegistered Nurse (RN) license, possibly with certification in utilization review
Work EnvironmentHealthcare facilities, insurance companies, utilization review organizationsHospitals, insurance companies, outpatient clinics
Job ResponsibilitiesAssess medical necessity, authorize treatments, make clinical decisions, often with greater autonomyReview medical records, support authorization processes, follow established guidelines

Utilization Review NPs typically have advanced clinical training and greater decision-making authority compared to Utilization Review Nurses. Both roles focus on evaluating medical necessity, but NPs often perform more complex assessments and can make independent recommendations, whereas nurses support the review process under supervision or guidelines.

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What job categories do people searching Utilization Review Np jobs in Indiana look for? The top searched job categories for Utilization Review Np jobs in Indiana are:
What cities in Indiana are hiring for Utilization Review Np jobs? Cities in Indiana with the most Utilization Review Np job openings:
Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Indiana as of July 2026, with employment types broken down into 1% Locum Tenens, 2% As Needed, 83% Full Time, 11% Part Time, and 3% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution.

Registered Nurse - Utilization Review

Trinityhealth

Mishawaka, IN

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago

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!!!
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.

What We Offer

  • 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

What You Will Do
  • 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
What You Will Need
  • 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.

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