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Entry Level Utilization Review Nurse Jobs in Colorado

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 ... State of Colorado licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse Basic Life Support ...

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Entry Level Utilization Review Nurse information

See Colorado salary details

$22

$44

$72

How much do entry level utilization review nurse jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for entry level utilization review nurse in Colorado is $44.46, according to ZipRecruiter salary data. Most workers in this role earn between $35.14 and $51.06 per hour, depending on experience, location, and employer.

What is an entry level utilization review nurse?

An Entry Level Utilization Review Nurse is a registered nurse (RN) who is new to the field of utilization review. Their main responsibilities include assessing medical records, ensuring that patients receive appropriate and necessary care, and verifying that health services are delivered according to established guidelines and insurance requirements. They typically work for hospitals, insurance companies, or managed care organizations and collaborate with healthcare providers to support quality patient outcomes while managing costs. This role often serves as a stepping stone to more advanced positions in healthcare administration or case management.

What are the key skills and qualifications needed to thrive as an entry level utilization review nurse, and why are they important?

To thrive as an Entry Level Utilization Review Nurse, you need a registered nurse (RN) license, knowledge of clinical guidelines, and an understanding of healthcare regulations. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) are often beneficial. Strong analytical thinking, attention to detail, and effective communication skills help you review cases accurately and collaborate with providers. These skills ensure appropriate care decisions, compliance with payer requirements, and optimal patient outcomes.

What are some common challenges faced by entry level utilization review nurses, and how can they overcome them?

Entry level Utilization Review Nurses often encounter challenges such as adapting to complex insurance policies, learning to review medical records efficiently, and communicating effectively with physicians and case managers. To overcome these challenges, new nurses should seek mentorship from experienced colleagues, participate in ongoing training sessions, and familiarize themselves with the organization's review protocols and documentation systems. Building strong communication skills and staying up to date with regulatory changes will also help in navigating the learning curve and ensuring successful case reviews.

What is the difference between Entry Level Utilization Review Nurse vs Utilization Review Nurse?

AspectEntry Level Utilization Review NurseUtilization Review Nurse
CredentialsRN license, possibly some certificationRN license, often with additional certifications
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, healthcare organizations
Job ResponsibilitiesAssist in reviewing patient cases, gather data, support senior staffEvaluate medical necessity, review patient records, make coverage decisions

The Entry Level Utilization Review Nurse typically supports the more experienced Utilization Review Nurse by gathering information and assisting in case reviews. Both roles require an RN license and work within healthcare or insurance settings, but the entry-level position involves more support tasks, while the Utilization Review Nurse makes critical coverage decisions.

What are the most commonly searched types of Utilization Review Nurse jobs in Colorado?

The most popular types of Utilization Review Nurse jobs in Colorado are:

What are popular job titles related to Entry Level Utilization Review Nurse jobs in Colorado?

For Entry Level Utilization Review Nurse jobs in Colorado, the most frequently searched job titles are:

What job categories do people searching Entry Level Utilization Review Nurse jobs in Colorado look for?

The top searched job categories for Entry Level Utilization Review Nurse jobs in Colorado are:

What cities in Colorado are hiring for Entry Level Utilization Review Nurse jobs?

Cities in Colorado with the most Entry Level Utilization Review Nurse job openings:

Entry Level Utilization Review Nurse jobs near you
Infographic showing various Entry Level Utilization Review Nurse job openings in Colorado as of August 2026, with employment types broken down into 82% Full Time, and 18% Part Time. Highlights an 91% In-person, and 9% Remote job distribution, with an average salary of $92,477 per year, or $44.5 per hour.

Utilization Review Registered Nurse : On Site Position

Pioneers Medical Center

Meeker, CO • On-site

$33.50 - $49/hr

Part-time

Re-posted 2 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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