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Chart Utilization Review Jobs in Colorado (NOW HIRING)

Delta Health

Case Manager

Delta, CO · On-site

$33.19 - $47.97/hr

Description Position Summary The Case Manager / Utilization Review (UR) is responsible for ... Perform ongoing chart and documentation reviews to support regulatory compliance and accurate ...

Delta Health

Case Manager

Delta, CO · On-site

$18.75 - $24.25/hr

Position Summary The Case Manager / Utilization Review (UR) is responsible for utilization review ... Perform ongoing chart and documentation reviews to support regulatory compliance and accurate ...

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Chart Utilization Review information

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

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is Chart Utilization Review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in Chart Utilization Review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

What are popular job titles related to Chart Utilization Review jobs in Colorado? For Chart Utilization Review jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Chart Utilization Review jobs in Colorado look for? The top searched job categories for Chart Utilization Review jobs in Colorado are:
What cities in Colorado are hiring for Chart Utilization Review jobs? Cities in Colorado with the most Chart Utilization Review job openings:
Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Colorado as of July 2026, with employment types broken down into 2% As Needed, 81% Full Time, 15% Part Time, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Case Manager

Delta Health

Delta, CO • On-site

$33.19 - $47.97/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 16 days ago

Job description

Description
Position Summary
The Case Manager / Utilization Review (UR) is responsible for utilization review, discharge planning, patient advocacy, social services, and documentation review. This role evaluates the medical necessity of hospital admissions, ensures appropriate patient status and level of care, and collaborates with physicians to support accurate clinical documentation.
The position works closely with patients, families, providers, hospital departments, payers, and community resources to coordinate care and facilitate safe, timely discharges.
Essential Responsibilities
  • Conduct concurrent reviews of hospital admissions to determine medical necessity and appropriate admission status.
  • Perform ongoing chart and documentation reviews to support regulatory compliance and accurate reimbursement.
  • Collaborate with physicians to ensure documentation accurately reflects patient severity and complexity of care.
  • Interview patients and families to assess discharge planning needs.
  • Develop and coordinate individualized discharge plans utilizing hospital and community resources.
  • Provide psychosocial support, patient advocacy, and education to patients and families.
  • Participate in interdisciplinary care conferences and coordinate care across departments.
  • Complete Social Determinants of Health (SDOH) screenings as required.
  • Present outlier cases to the Utilization Review Committee and attend committee meetings.
  • Assist with denials management, audits, and payer-related issues.
  • Serve as a resource for staff regarding medical necessity, level of care, and discharge planning.
  • Maintain confidentiality and support a positive team environment.

Qualifications
Required
  • Current Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in the State of Colorado.
  • Minimum three (3) years of hospital-based nursing experience.
  • Working knowledge of CMS regulations and medical necessity requirements.
  • Experience with EMR systems, preferably Meditech.
  • Strong communication, organizational, analytical, and problem-solving skills.
  • Ability to prioritize workload, manage multiple tasks, and work independently.
  • Strong interpersonal skills with the ability to effectively collaborate with physicians, staff, patients, and families.

Preferred
  • Experience in utilization review, case management, discharge planning, or care coordination.
  • Knowledge of Milliman Care Guidelines and quality improvement processes.

Why Join Delta Health?
Comprehensive Benefits Package
  • Medical, RX, Dental & Vision - Low premiums with 100% coverage on services provided within the Delta Health system, and no deductibles or co-pays. Includes access to massage therapy, acupuncture, and chiropractic care.
  • Life & Disability Insurance - Employer-paid coverage for your peace of mind.
  • Time Off - Over 4 weeks of paid vacation annually (including sick and personal leave) for full-time staff.
  • Retirement - 403(b) plan with up to a 2% employer match.

Work-Life Balance in a Stunning Location
Located on the Western Slope of the Rocky Mountains, Delta offers an unmatched combination of small-town charm, affordability, and natural beauty. Enjoy year-round outdoor activities such as hiking, skiing, mountain biking, fishing, and exploring the Grand Mesa and surrounding public lands. Whether you're raising a family or looking for work-life balance, Delta provides a safe, friendly community with a slower pace and a high quality of life. Delta is surrounded by the Grand Mesa, Uncompahgre Plateau, and nearby wineries, offering a unique blend of adventure and relaxation.
Delta Health is a county-wide healthcare system with more than 100 years of dedication to serving our community. Our 49-bed hospital and outpatient locations across Delta County are committed providing remarkable care in a healing environment. We operate with the core belief: Excellence. Every Patient. Every Time.
We are an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity or expression, age, national origin, disability, veteran status, or any other protected characteristic

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