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Utilization Reviewer Jobs in Indiana (NOW HIRING)

Astyra Corporation

Clinical Reviewer

Indianapolis, IN · Remote

$38 - $40/hr

Associate's degree (Bachelor's preferred) or diploma from an accredited nursing program * 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience * 2+ years of medical ...

Parkview Health

Utilization Review Analyst

Fort Wayne, IN · On-site

$13.05 - $19.57/hr

Summary Performs clerical, customer service and issue resolution duties within the UM/Reimbursement area. The main focus is to obtain insurance authorizations and complete data entry functions to ...

MISO

Manager Resource Utilization

Carmel, IN · On-site

$166K - $191K/yr

As MISO's Manager - Resource Utilization, you will lead a team at the center of critical ... For further information, please review the Know Your Rights notice from the Department of Labor.

MISO

Manager Resource Utilization

Carmel, IN · On-site

$166K - $191K/yr

Description As MISO's Manager - Resource Utilization, you will lead a team at the center of ... For further information, please review the Know Your Rights notice from the Department of Labor.

MISO Energy

Manager Resource Utilization

Carmel, IN · On-site

$166K - $191K/yr

Description As MISO's Manager - Resource Utilization, you will lead a team at the center of ... For further information, please review the Know Your Rights ( notice from the Department of Labor.

TEEMA Group

RN Case Manager

Evansville, IN · On-site

$83K - $93K/yr

Conduct utilization review (UR) and ensure appropriate level of care * Collaborate with physicians, nurses, and support teams * Educate patients and families on post-discharge plans * Document and ...

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)

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Indiana

Utilization Reviewer information

See Indiana salary details

$29.5K

$36.2K

$41.9K

How much do utilization reviewer jobs pay per year?

As of Jun 28, 2026, the average yearly pay for utilization reviewer in Indiana is $36,152.00, according to ZipRecruiter salary data. Most workers in this role earn between $32,400.00 and $40,000.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a Utilization Reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A utilization reviewer evaluates medical records and treatment plans to determine the necessity and appropriateness of healthcare services. They ensure that services comply with insurance policies and industry standards, often using healthcare management software and adhering to regulatory guidelines. This role supports cost containment and quality assurance in healthcare organizations.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in healthcare or insurance, strong analytical skills, and familiarity with medical coding and documentation are important; some roles may require certification such as the Certified Professional Utilization Review (CPUR).

What jobs pay 2000 a day?

Utilization reviewers typically do not earn $2000 a day; such high daily earnings are more common in specialized roles like senior surgeons, high-level consultants, or certain executive positions. These roles often require advanced certifications, extensive experience, and work in high-paying industries such as healthcare, finance, or law. Most utilization review positions offer salaries that are significantly lower than this daily rate.

What Does a Utilization Reviewer Do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What job makes $10,000 a month without a degree?

A utilization reviewer typically earns between $4,000 and $8,000 per month, depending on experience and location, and usually requires relevant healthcare or insurance knowledge. Jobs that can pay $10,000 a month without a degree include high-level sales, real estate brokers, or certain skilled trades like commercial pilots or specialized technicians, often requiring certifications or extensive experience. These roles often involve self-employment, commissions, or high-demand skills that compensate well without formal college degrees.

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

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Indiana? For Utilization Reviewer jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Utilization Reviewer jobs in Indiana look for? The top searched job categories for Utilization Reviewer jobs in Indiana are:
What cities in Indiana are hiring for Utilization Reviewer jobs? Cities in Indiana with the most Utilization Reviewer job openings:
What are popular job titles related to Utilization Reviewer jobs in IN? For Utilization Reviewer jobs in IN, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Indiana as of June 2026, with employment types broken down into 25% Full Time, 69% Part Time, and 6% Contract. Highlights an 51% Physical, 2% Hybrid, and 47% Remote job distribution, with an average salary of $36,152 per year, or $17.4 per hour.

Utilization Management Nurse

SIHO HOLDING INC

Columbus, IN • On-site

Other

Posted 2 days ago

Job description

Job Title: Utilization Management Nurse
Reports To: Manager of Utilization Management
Employment Type: Full-Time, Exempt
Brief Description of Duties:
This position is reserved for a licensed Registered Nurse who will perform the Utilization Management (UM) services for SIHO (and affiliated business lines') members. This individual's primary role is to ensure that health care services are administered with quality, cost effectiveness, and compliance to plan guidelines. By performing review of services prospectively, retrospectively, and throughout the episode of care, the UM nurse will make coverage determinations influencing how services are allocated to SIHO's various member populations. A candidate's ability to perform quality reviews within strict efficiency standards is required for this position. Key responsibilities are as follows:
  • Pre-service, concurrent, and post-service review for medical necessity of health care services utilizing enrollee medical records and established guidelines set by SIHO and/or state and federal (CMS) guidelines
  • Interaction with the member, health care provider, and/or other care team members to complete reviews in most time-efficient manner
  • Interaction with the SIHO Medical Director or external Medical Reviewers as needed to ensure proper medical necessity decisions are made in a timely manner
  • Appropriate documentation of the entire review process utilizing the established documentation system and desk procedures to guarantee accurate reporting metrics and data integrity
  • Complete case review and manage turnaround times to assure determinations are rendered within the contractual and regulatory turnaround times established by SIHO and CMS
  • Assist in problem resolution and provide guidance to members of the team and cohorts
  • Interpret and abide by organizational policies and procedures; review work regularly to ensure that policies and guidelines are appropriately applied
  • Act as a clinical resource to the department and other organization members for services pertaining to medical management, utilization review, and medical necessity
  • Act and perform within the scope of professional nursing practice; display responsibility in supporting and participating in department strategies and efforts focused on quality improvement
  • Responsible for the early identification and assessment of members for inclusion in disease management or care management programs
  • Assist in the identification and reporting of Potential Quality of Care concerns and Fraud, Waste and Abuse incidents
  • Work as an interdisciplinary team member within Medical Management for all lines of business and commercial group plans
  • Show effective prioritization, efficiency and accuracy of work product in alignment with department goals.

Minimum Skills Requirement:
  • Registered Nurse with current, unrestricted license in primary state of employment (position may require additional licensing in other states as necessary)
  • Previous UM or Health Plan experience highly preferred
  • Desire to work in a fast-paced environment with focus on efficiency and attention to detail while maintaining quality
  • Self-directed organizational and prioritization skills, and independent time management skills required
  • Sound clinical background with experience in the clinical field
  • Excellent verbal and written communication skills
  • Microsoft Office Experience: Outlook, Word, Excel

Apply