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Utilization Review Nurse Jobs in Indiana (NOW HIRING)

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Critical utilization management functions during the admission phase include admission review for ... Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Critical utilization management functions during the admission phase include admission review for ... Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or ...

Beacon Health System

W/Alt UM Nurse (BHS)

Granger, IN · On-site

Critical utilization management functions during the admission phase include admission review for ... Facilitating discharge planning by working closely with Nurses and Clinical Social Workers and/or ...

GQR Global Markets

RN Case Manager

Indianapolis, IN · On-site

$1.7K - $1.7K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Indianapolis, Indiana Start Date: September 7, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute ...

TEEMA Group

RN Care Manager

Evansville, IN · On-site

$85K - $95K/yr

Perform utilization review (UR) and payer communication * Support hospital goals: reduce LOS, prevent readmissions, improve outcomes ✅ What You Bring: * Active RN license (Indiana or compact)

EDGEWATER HEALTH

NURSE MANAGER

Gary, IN · On-site

Ensures standards for admission, utilization review, and concurrent review are followed. Staff Leadership and Development * Supervises nursing personnel and provides clinical guidance to residential ...

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 ...

ScionHealth

Case Manager II

Indianapolis, IN · On-site

... utilization review and management, and discharge planning. Essential Functions Care Coordination ... Bachelor's Degree in nursing or social work: BSN, MSN, BSW or MSW (Preferred) Licenses ...

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Utilization Review Nurse information

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How much do utilization review nurse jobs pay per hour?

As of Sep 3, 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 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 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.

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 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 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?

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For Utilization Review Nurse jobs in Indiana, the most frequently searched job titles are:

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Cities in Indiana with the most Utilization Review Nurse job openings:

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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 1% As Needed, 79% Full Time, 15% Part Time, 1% Temporary, and 4% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $83,687 per year, or $40.2 per hour.

QUALITY REVIEW NURSE SPECIALIST

Health & Hospital Corporation of Marion County

Indianapolis, IN • On-site

Full-time

Posted 16 days ago

Job description

Health and Hospital Corporation is an organization that celebrates diversity, and seeks to employ a diverse workforce. We actively encourage all individuals to apply for employment and to seek advancement opportunities. Health and Hospital Corporation also provides reasonable accommodations to qualified individuals with disabilities as required by law. For additional questions please contact us at: hrmail@hhcorp.org.
Job Role Summary
Assists the Vice President of Long Term Care and other department personnel in the review and analysis of care and services provided by HHC owned nursing homes and licensed residential facilities. Performs on site and office review of various clinical resident care services and nursing management operations at the long term care facilities and prepares related reports for the long term care department, individual facilities and the contract management company. Assists in the analysis of various aspects of nursing home operations using professional standards of practice and industry benchmarks and in the preparation of reports for the HHC Board of Directors' Planning Committee. This position is responsible for promoting health and wellbeing of long term care residents of Health and Hospital Corporation Marion County nursing facilities by promoting preventive, therapeutic, and supportive care based on standards of practice and in compliance with all applicable regulatory requirements.
Essential Duties
Responsibility 1: 70%
  • Performs quality review oversight visits to HHC owned nursing homes and retirement communities as assigned. May serve as a member of a quality review team or at times may visit assigned facilities as the sole representative from the HHC Long Term Care Department. Maintains a professional and supportive role when interacting with the nursing home and licensed residential facility staff providing helpful observations and suggestions.
  • Performs various auditing/review activities during the site visits including but not limited to: medication administration observations, wound care and treatment administration, personal care services, meal service, clinical record reviews and review of nursing management records. At times may assist the other members of the quality review team to complete their assigned tasks. Other review tasks may include: resident or family interviews, review of quality assurance records, in-service training records, personnel files, incident report logs, professional facility consultant reports and other records as assigned. Must be knowledgeable and mindful of potential liability and other risk management issues and methods for taking appropriate preventative or corrective action.
  • Participates in the exit conferences held with facility management and the quality reviewers and provides summary information regarding significant observations during the facility visit including specific resident and employee identification when possible. When requested, participates in taking notes at the exit conference for exit conference reports.
  • Prepares a written site visit report following each facility visit in cooperation with other quality review team members who participated in the facility visit. Reviews report for accuracy, and clarity. Distributes reports in a confidential manner to all parties and maintains HHC records.
  • Assures the retention and confidentiality of all data materials from facility visits and forwards to the department Executive Assistant for proper storage/retention.

Responsibility 2: 30%
  • Participates in the compilation and completion of quarterly and other reports prepared for the HHC Board of Directors' Planning Committee.
  • May attend HHC Planning Committee meetings as assigned to represent the Long Term Care Department or to present a special report.
  • Assists in the completion and follow up of any requests or directives resulting form the Planning Committee meetings as assigned.
  • Accepts phone calls from residents, family members and interested parties in the absence of other Long Term Care Department staff or as assigned. Receives concerns or information in a manner that reflects good customer service practices and prepares detailed written information for the Vice President's review and processing.
  • Attends community and professional association functions and meetings representing HHC Long Term Care division as requested.
  • Participates in the development of educational materials and staff training programs relative to long term care.
  • Assists in development of departmental policies, procedures and forms for use in the departmental functions.
  • In the absence of the Executive Assistant, makes travel arrangements/reservations for department staff conducting out of town facility site visits.
  • Must be able to communicate effectively in verbal and written communications and able to adhere to deadlines and interruptions and frequent assignment changes, etc. Must have good customer service skills for interacting with facility residents and personnel on site visits as well as the general public.

Qualifications
  • Graduate of an approved school of nursing (diploma, associate or B.S. degree).
  • Access to own vehicle and current automobile insurance.
  • 5 - 10 years of previous experience in long term care in a nursing management role.
  • Knowledge of local/State/Federal laws and regulations applicable to state licensure of nursing homes and residential nursing facilities, federal regulations for skilled nursing homes and participation in Medicare and Medicaid programs, communicable disease control, and other applicable long term care requirements.

Licenses/Certifications Required
  • Licensed Registered Nurse (Indiana).
  • Valid Indiana Driver's license.

Working Environment
  • Unconfined sitting 75%
  • Confined sitting 15%
  • Standing or walking 10%
  • Steady use of hands or fingers - Typing and filing 85%
  • Lift, carry, etc. with arms and legs - Carrying small boxes to meetings 15%
  • Ability to perform driving functions in normal course of work day with confined sitting for several hours at times.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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