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Utilization Review Nurse Jobs in Indiana (NOW HIRING)

UHS

MGR - UTILIZATION REVIEW / MGMT

Bloomington, IN · On-site

... oversees utilization management including, but not limited to: utilization review, case ... Must have Registered Nurse license or Master's Degree. Experience: 5-7 yrs acute inpatient ...

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Utilization Review Nurse information

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$40

$65

How much do utilization review nurse jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for utilization review nurse in Indiana is $40.23, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.20 per hour, depending on experience, location, and employer.

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

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What does a utilization review nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

What does a utilization review nurse do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

How much do utilization review nurses make?

Utilization review nurses in Texas typically earn an average annual salary of around $70,000 to $85,000, depending on experience, certifications, and employer. Salaries can vary based on healthcare setting, location, and workload, with some experienced nurses earning higher wages or additional benefits.

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

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

More about Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Indiana? The most popular types of Utilization Review Nurse jobs in Indiana are:
What are popular job titles related to Utilization Review Nurse jobs in Indiana? For Utilization Review Nurse jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Utilization Review Nurse jobs in Indiana look for? The top searched job categories for Utilization Review Nurse jobs in Indiana are:
What cities in Indiana are hiring for Utilization Review Nurse jobs? Cities in Indiana with the most Utilization Review Nurse job openings:
What are popular job titles related to Utilization Review Nurse jobs in IN? For Utilization Review Nurse jobs in IN, the most frequently searched job titles are:
Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Indiana as of August 2026, with employment types broken down into 100% Full Time. Highlights an 60% In-person, and 40% Remote job distribution, with an average salary of $83,687 per year, or $40.2 per hour.

Registered Nurse - Utilization Review

Trinityhealth

Mishawaka, IN • On-site

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

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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