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Discharge Planner Utilization Review Jobs in Colorado

GSK Solutions

RN Case Manager

Grand Junction, CO · On-site

Maintain knowledge of case management, discharge planning, utilization review, and nursing practices. * Support quality, operational, and financial outcomes. Requirements * Current unrestricted ...

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Discharge Planner Utilization Review information

What is a discharge planner utilization review?

Discharge Planner Utilization Review professionals are healthcare workers who coordinate patient discharges from hospitals or medical facilities while ensuring appropriate utilization of healthcare services. They assess patients' continuing care needs, develop safe discharge plans, and review the necessity and efficiency of the care provided. Their role bridges clinical care and administrative requirements, helping to prevent unnecessary hospital stays and ensuring patients transition smoothly to home or other care settings. These professionals often work closely with physicians, nurses, social workers, and insurance companies to promote optimal patient outcomes and cost-effective healthcare.

How does a discharge planner utilization review collaborate with interdisciplinary teams to ensure effective patient transitions?

Discharge Planner Utilization Review professionals work closely with physicians, nurses, social workers, and insurance representatives to coordinate safe and timely patient discharges. They facilitate communication between team members, assess patients' post-hospital needs, and help secure appropriate resources such as home health care or rehabilitation services. Their role is vital in preventing readmissions by ensuring that all aspects of a patient's care plan are addressed and that transitions occur smoothly. Regular interdisciplinary meetings and case conferences are common practices to align on patient care goals.

What are the key skills and qualifications needed to thrive as a discharge planner utilization review?

To thrive as a Discharge Planner Utilization Review professional, you generally need a clinical background such as RN or social worker licensure, strong knowledge of discharge planning protocols, and familiarity with healthcare regulations. Proficiency with electronic health records (EHRs), case management software, and utilization review tools is typically required. Excellent communication, problem-solving, and organizational skills help in coordinating care and advocating for patient needs. These competencies ensure safe, efficient patient transitions and compliance with healthcare policies, ultimately optimizing patient outcomes and resource use.

What is the difference between Discharge Planner Utilization Review vs Discharge Planner?

AspectDischarge Planner Utilization ReviewDischarge Planner
Primary RoleEvaluates medical necessity and appropriateness of patient discharges for insurance and healthcare complianceCoordinates patient discharges, ensures proper placement, and communicates with healthcare teams
CredentialsTypically requires a social work, nursing, or healthcare background with certification in utilization reviewUsually requires social work or nursing credentials, with focus on discharge planning
Work EnvironmentHospitals, insurance companies, or healthcare facilities involved in utilization reviewHospitals, rehab centers, or skilled nursing facilities

While both roles involve discharge processes, Discharge Planner Utilization Review focuses on assessing medical necessity for insurance purposes, whereas Discharge Planner manages patient discharge logistics and coordination. Understanding these differences helps clarify career paths and employer expectations in healthcare settings.

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

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

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

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

Discharge Planner Utilization Review jobs near you
Infographic showing various Discharge Planner Utilization Review job openings in Colorado as of June 2026, with employment types broken down into 1% As Needed, 73% Full Time, 21% Part Time, and 5% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution.

Utilization Review Registered Nurse : On Site Position

Meeker, CO • On-site

Pioneers Medical Center
Health Care and Social Assistance • 201 - 500 employees
Learn more about Pioneers Medical Centerexternal

$33.50 - $49/hr

Other

Re-posted 25 days ago

Job description

Reports To : Director of Nursing; Acute and Emergency Department
FLSA Classification: Part-Time, Non-Exempt, Hourly $33.50 - $49-53
Essential Functions:
The Part-Time Utilization Review Nurse is a Registered Nurse (RN) responsible for conducting utilization reviews to determine the medical necessity and appropriateness of patient admissions, continued hospital stays, and the level of care provided. This role ensures compliance with regulatory requirements and payer guidelines, proactively identifies potential barriers to discharge, and works to prevent claim denials, thereby supporting efficient patient throughput and optimal resource utilization within the hospital.
- Perform concurrent and retrospective utilization reviews for all patient admissions and continued stays, applying established medical necessity criteria (e.g. InterQual, Milliman Care Guidelines), and payer specific guidelines.
- Communicate effectively with attending physicians, residents, and other healthcare providers regarding medical necessity, documentation requirements, and alternative levels of care.
- Identify and address potential barriers to discharge, collaborating with the Case Management team to facilitate timely patient progression.
- Document all review activities, including approvals, denials, and appeals processes, accurately and thoroughly in the electronic health record (EHR) system.
- Assist in the preparation and submission of appeals for denied services, providing clinical rationale and supporting documentation.
- Stay current with Medicare, Medicaid, and commercial payer regulations, policies, and medical necessity criteria.
- Collaborate with the Case Management team to ensure seamless coordination between utilization review and discharge planning activities.
- Participate in interdisciplinary team meetings to discuss patient status, care progression, and discharge readiness.
- Provide education to physicians and other staff on documentation requirements for medical necessity.
- Monitor readmissions and avoidable days in Meditech for quality improvement initiatives.
- Coordinate in advance discharge planning for orthopedic surgical patients, ensuring timely referrals, equipment orders, and post-discharge services.
- Actively participate in the Utilization Review (UR) Committee.
- Perform other duties as assigned to support utilization management, case management, and hospital operations.
- Other duties as assigned.
Education and Experience:
- Previous experience in managing staff and schedules required.
- Active, unencumbered Registered Nurse (RN) license in Colorado or Compact-state license that includes Colorado.
- Two (2) to three (3) years' of recent clinical experience in an acute care setting required.
- One (1) year of experience in Utilization Review or Case Management preferred.
- Strong knowledge of Medicare, Medicaid, and commercial payer regulations, as well as medical necessity criteria (e.g., InterQual, Milliman Care Guidelines).
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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