UR Specialist-Non Exempt

Major Hospital; Shelbyville (IN); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Major Hospital in the United States is seeking a skilled utilization review professional to review medical records for necessity and appropriateness of care. You will collaborate with providers, staff, insurers, and case managers to ensure patients receive the right level of care per industry standards.

The role requires several years of clinical experience and proficiency with healthcare information systems, with PRN status on Integrated Case Management and weekend/evening variances.

Qualifications

• Several years of experience in a clinical setting.
• Experience with healthcare information systems and software.

Responsibilities

• Review and evaluate medical records for necessity and appropriateness of services.
• Collaborate with healthcare providers, clinical staff, case managers, insurance companies, clinical coders and patient access staff to ensure appropriate level of care.
• Interpret data and identify trends to support utilization review.
• Maintain confidentiality and adhere to regulatory standards.

Skills

Clinical experience

Healthcare IT systems

Education

Bachelor's degree in nursing, healthcare management, or related field

Job description

Full Time , Days , 930-6 Monday thru Thursday. Once trained you will work from home.

Posted 08/20/2026

JOB SUMMARY AND SPECIFICATIONS

JOB SUMMARY

Responsible for reviewing and evaluating the medical record for necessity and appropriateness of healthcare services and treatments before, during and after care. Collaborating with healthcare providers, clinical staff, case managers, insurance companies, clinical coders and patient access staff to ensure the patients are receiving the right level of care per industry standards.

MINIMUM QUALIFICATIONS

Professional & Technical Skills

• Several years of experience in a clinical setting
• Experience with healthcare information systems and software

Education

Bachelor's degree in nursing, healthcare management, or a related field

License(s) or Certifications(s)

Proven experience in utilization management or a related field, with a deep understanding of healthcare delivery systems and payment models. Strong knowledge of medical terminology, diagnostic and procedural coding, and reimbursement methodologies. Excellent analytical and problem-solving skills, with the ability to interpret complex healthcare data and identify trends and patterns. Experience in communication with the ability to liaise effectively with diverse stakeholders, including medical staff, insurance providers, and regulatory agencies. Proficient computer skills, including experience with electronic health record systems and utilization management software. Strong attention to detail and ability to adhere to strict confidentiality guidelines. Sound knowledge of applicable laws, regulations, and accreditation standards related to utilization review. Demonstrated ability to work independently and manage multiple priorities in a fast-paced environment.

Other Skills or Requirements

PRN status with Integrated Case Management team. Weekend availability required. Some evenings required. Must work well with a team. Acute care and D/C planning experience preferred.

Skilled to Care for Certain Age-Related Patient Groups (incumbents will be skilled in the care of the following patient groups)