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Behavioral Utilization Review Jobs in Colorado (NOW HIRING)

UHS

DIR - UTILIZATION REVIEW / MGMT

Colorado Springs, CO · On-site

$85K - $120K/yr

The Director of Utilization Review is responsible for directing and overseeing the Utilization ... Strong knowledge of crisis intervention, risk assessment, and behavior management. 5. Maintain ...

All Points North

Integrated Care Advisor

Edwards, CO · On-site

$60K - $75K/yr

Knowledge of behavioral health levels of care (RTC, PHP, IOP, OP) * Understanding of utilization review, medical necessity, and insurance processes * Ability to facilitate financial conversations ...

All Points North

Integrated Care Advisor

Edwards, CO

$60K - $75K/yr

Knowledge of behavioral health levels of care (RTC, PHP, IOP, OP) * Understanding of utilization review, medical necessity, and insurance processes * Ability to facilitate financial conversations ...

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Behavioral Utilization Review information

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

AspectBehavioral Utilization ReviewBehavioral Case Manager
CredentialsLicensed mental health professionals, certifications varyLicensed clinical social workers, counselors, or therapists
Work EnvironmentReview settings, insurance companies, healthcare facilitiesDirect patient interaction, hospitals, outpatient clinics
Employer & IndustryInsurance companies, healthcare organizationsHospitals, mental health agencies, managed care
Primary FocusAssessing medical necessity, reviewing treatment plansCoordinating care, supporting treatment adherence

Behavioral Utilization Review primarily involves evaluating the necessity of mental health services through review processes, while Behavioral Case Managers focus on coordinating patient care and supporting treatment plans. Both roles require mental health credentials but differ in daily tasks and work settings.

How to become a behavioral utilization review?

To become a behavioral utilization review specialist, candidates typically need a bachelor's degree in psychology, social work, nursing, or a related field. Relevant experience in mental health or healthcare settings, along with knowledge of insurance policies and utilization review processes, is important; some roles may require certification such as the Certified Professional in Utilization Review (CPUR).

Is behavioral utilization review a stressful job?

Behavioral utilization review can be stressful due to the need to evaluate complex mental health cases, meet strict deadlines, and handle sensitive patient information. The role often requires strong attention to detail, critical thinking, and emotional resilience, which can contribute to job-related stress.

What are popular job titles related to Behavioral Utilization Review jobs in Colorado?

For Behavioral Utilization Review jobs in Colorado, the most frequently searched job titles are:

What job categories do people searching Behavioral Utilization Review jobs in Colorado look for?

The top searched job categories for Behavioral Utilization Review jobs in Colorado are:

What cities in Colorado are hiring for Behavioral Utilization Review jobs?

Cities in Colorado with the most Behavioral Utilization Review job openings:

Behavioral Utilization Review jobs near you
Infographic showing various Behavioral Utilization Review job openings in Colorado as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 100% In-person job distribution.

Utilization Review Coordinator

Aurora, CO • On-site

Alsos Behavioral Health
See more jobs at Alsos Behavioral Healthexternal

$64K/yr

Full-time

Posted 6 days ago

Job description

EOE Statement
We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.
Description
Position Summary
Salary $64,000
The UR and RCM Support Coordinator is responsible for securing and maintaining payer authorizations across all levels of care for residential substance use disorder (SUD) treatment, including ASAM Levels 3.5 and 3.7, while also providing cross-functional support to the Revenue Cycle Management department. This role serves as a key link between the clinical team, payers, and the RCM department, ensuring that medical necessity is clearly documented, communicated, and defended throughout each patient's episode of care.
Reporting to the Director of Utilization Review with a dotted-line relationship to the Director of Revenue Cycle Management, the UR and RCM Support Coordinator works in close partnership with billing, denials, appeals, and clinical leadership to drive authorization approval rates, prevent denials at the front end, and protect revenue across the multi-state network of facilities. This is a high-visibility role with direct impact on length of stay, denial rates, and net collections.
Essential Duties and Responsibilities
Authorization Management
  • Complete pre-certification, initial, concurrent, and discharge reviews with commercial, Medicaid, and Medicaid managed care payers for residential SUD levels of care (ASAM 3.1, 3.5, 3.7, and detox where applicable).
  • Submit clinical information to payers within required timeframes, using ASAM criteria and payer-specific medical necessity guidelines to justify admission, continued stay, and level of care.
  • Track all authorization requests, approvals, days approved, next review dates, and denials in the UR tracking system; ensure no patient day is at risk due to a missed or expired authorization.
  • Escalate authorization issues, denials, or peer-to-peer requests to the Director of Utilization Review and Director of RCM in real time, along with clinical leadership as appropriate.

Peer-to-Peer and Denial Prevention
  • Coordinate, prepare, and schedule peer-to-peer reviews between facility physicians and payer medical directors; provide the rendering clinician with a written summary of medical necessity points prior to each call.
  • Document peer-to-peer outcomes, including outcome reason, reviewer name, and any payer-specific feedback for use in future submissions.
  • Partner with the Director of Utilization Review and Director of RCM, along with the appeals team, to identify trends in concurrent denials and translate findings into documentation and clinical workflow improvements.
  • Support the appeals process by providing UR notes, clinical timelines, and the authorization history needed for first- and second-level appeals.

Clinical Documentation Partnership
  • Review clinical documentation daily for alignment between the billed level of care and the documented level of care; flag and address mismatches before they generate denials (a known driver of pre-payment review and payer recoupment risk).
  • Provide real-time coaching and written feedback to clinicians, therapists, and medical providers on documentation elements required to meet ASAM 3.5 and 3.7 medical necessity (e.g., dimensional risk ratings, withdrawal management needs, biomedical and behavioral complications, treatment response, and continued-stay justification).
  • Partner with clinical leadership to maintain documentation templates and standards that satisfy commercial payer, state Medicaid, and accreditation requirements across Arkansas, Colorado, Indiana, Kentucky, and Ohio.

Revenue Cycle Coordination
  • Work alongside the RCM team to support resolution of authorization-driven holds, write-off recommendations, and pre-payment review responses, providing UR expertise and clinical context as needed.
  • Provide the billing team with accurate authorization numbers, approved date ranges, level-of-care designations, and modifier guidance to ensure clean claim submission.
  • Participate in standing meetings with the Director of Utilization Review, Director of RCM, billing manager, and denials/appeals leads to review denial trends, hold billing volume, AR aging by payer, and authorization-related risk.
  • Contribute to executive-facing reporting on UR performance, including authorization approval rates, average days authorized, peer-to-peer outcomes, and denial root cause.
  • Support the RCM team as needed with cash posting, billing, and denial reconciliation activities, particularly during peak volume, staff coverage gaps, or special projects.
  • Participate in the implementation, testing, and rollout of new software platforms, payer portals, and operational processes; provide UR-side workflow input, validate functionality, and assist with end-user training and adoption across facilities.

Payer Relationships and Compliance
  • Maintain working knowledge of payer-specific medical necessity criteria, review timelines, submission portals, and documentation requirements for Ambetter, UnitedHealthcare, Optum, Aetna, Cigna, Anthem/Elevance, Colorado Access, state Medicaid programs, and Medicaid managed care plans operating in network states.
  • Track payer policy changes, level-of-care criteria updates, and contract requirements; communicate impact to RCM and clinical leadership.
  • Support payer pre-payment reviews, audits, and medical record requests by assembling complete UR packets within required timeframes.
  • Maintain strict compliance with HIPAA, 42 CFR Part 2, state confidentiality laws, and organizational policy in all payer communications.

Position Requirements
Qualifications
Required
  • Active, unrestricted clinical license in good standing (RN, LPN, LCSW, LPC, LMFT, LCDC/LADC, or equivalent behavioral health license) OR equivalent UR experience acceptable to the organization.
  • Minimum of 2 years of utilization review, case management, or care coordination experience in behavioral health, substance use disorder, or mental health treatment.
  • Demonstrated working knowledge of ASAM Criteria, with the ability to apply dimensional assessments to medical necessity submissions.
  • Direct experience completing concurrent reviews with commercial and/or Medicaid payers for residential SUD or behavioral health levels of care.
  • Strong written and verbal communication skills, with the ability to summarize complex clinical information into concise medical necessity language.
  • Proficient in electronic health records, payer portals, and Microsoft Office (Excel, Word, Outlook, Teams).

Preferred
  • Experience supporting multi-state operations or multi-facility provider networks.
  • Prior experience working within or alongside a Revenue Cycle Management department, including familiarity with denials, appeals, and AR workflows.
  • Working knowledge of state Medicaid behavioral health billing requirements (e.g., Ohio rendering practitioner/NPI rules, Colorado HCPF supervising clinician and modifier requirements, Kentucky and Indiana ASAM billing structures, Arkansas OBHS billing).
  • Experience handling pre-payment reviews and supporting payer audit responses.

Knowledge, Skills, and Abilities
  • Ability to think both clinically and financially - to recognize when documentation will not support the billed level of care and intervene before claims are submitted.
  • Strong organizational skills and the ability to manage a high volume of concurrent reviews across multiple facilities, payers, and time zones without missing deadlines.
  • Comfort working independently in a remote environment while maintaining tight collaboration with clinical, billing, and leadership teams.
  • Sound judgment in escalating risk: when to request a peer-to-peer, when to engage the Director of Utilization Review or Director of RCM, and when to involve clinical leadership.
  • Discretion and professionalism in all payer-facing communications; the UR Coordinator represents the organization to payer medical directors and case managers.

Key Performance Indicators
Performance will be evaluated against, but not limited to, the following measures:
  • Initial authorization approval rate by payer and level of care.
  • Concurrent review approval rate and average days approved per review.
  • Peer-to-peer overturn rate.
  • Concurrent denial rate and root-cause distribution (medical necessity vs. documentation vs. timeliness).
  • Timeliness of review submission (meeting or exceeding payer deadlines).
  • Authorization-related hold billing volume and aging.

Working Conditions and Physical Requirements
  • Primarily remote, office-based work; extended periods of computer and phone use.
  • Standard business hours with occasional flexibility required to meet payer deadlines or accommodate peer-to-peer scheduling across time zones.
  • Occasional travel to facilities or payer meetings may be required.

Full-Time/Part-Time
Full-Time
Shift
-not applicable-
Position
Utilization Review Coordinator
Division
Sheridan Grove Recovery
Number of Openings
1
Exempt/Non-Exempt
Non-Exempt
Hiring Manager(s)
Tracy Polk
Location
DEN1
About the Organization
Healing with Dignity, Recovery with Purpose.
Oak Grove Recovery proudly serves the Columbus, Ohio, community by providing compassionate, judgment-free addiction treatment. Our dedicated team is available 24/7 to support each individual on their healing journey, offering care rooted in dignity, purpose, and unwavering respect.
This position is currently accepting applications.

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