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Insurance Utilization Review Jobs in Colorado (NOW HIRING)

InnovAge

Continued Stay Coordinator

Denver, CO · On-site +1

$22.84 - $27.40/hr

Experience supporting continued stay, utilization management, or regulatory eligibility reviews in ... Our extensive benefits package includes medical/dental/vision insurance, short and long-term ...

Innova

Home Care LPN - Lakewood, CO

Lakewood, CO

$25.75 - $35/hr

Participates in utilization review of medical records as assigned. * Adheres to Agency standards ... auto insurance as required by law. * High School Diploma or GED PREFERRED * 3+ yrs as LPN in a ...

Avenues Recovery

PMHNP/FNP - Detox Treatment Center

Denver, CO · On-site

$111K - $141K/yr

... utilization review (UR) teams Ensure compliance with state regulations, JCAHO, CARF, and ASAM ... insurance Short- and long-term disability Life insurance and AD&D Pet Insurance Legal coverage ...

Avenues Recovery

PMHNP/FNP - Detox Treatment Center

Denver, CO · On-site

$111K - $141K/yr

... utilization review (UR) teams Ensure compliance with state regulations, JCAHO, CARF, and ASAM ... insurance Short- and long-term disability Life insurance and AD&D Pet Insurance Legal coverage ...

We Care Staffing

LPN In-Home Services

Aurora, CO

$26.25 - $35.75/hr

Participates in utilization review of medical records as assigned. * Adheres to Agency standards ... auto insurance as required by law. * High School Diploma or GED PREFERRED * 3+ yrs as LPN in a ...

inno

Intake Coordinator- Hybrid

Colorado Springs, CO · Hybrid

$17.75 - $24.25/hr

... insurance lifetime caps and prior authorization periods. * Resolve patient/payor issues in a timely manner. * Run various reports to keep up with patient caseload and Utilization Review Maintenance.

Mgahomecare

RN Clinical Supervisor

Denver, CO

$85K - $90K/yr

Compliance and participation in the continuing quality improvement and utilization review of ... Current state driver's license and automobile insurance. * Possess excellent written and oral ...

ScionHealth

Pharmacy Manager

Aurora, CO · On-site

$59.95 - $89.95/hr

Performs prospective and/or retrospective drug utilization review. * Participates in the ... Insurance, Paid Time Off, and Wellne Qualifications Education * Bachelor's Degree in Pharmacy or ...

InnovAge

Psychiatric Nurse Practitioner

Pueblo, CO

$115K - $185K/yr

Contribute to case review, consultation, and utilization review * Research and utilize evolving ... and auto insurance as required by law. PREFERRED * Experience working with geropsychiatric ...

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Insurance Utilization Review information

See Colorado salary details

$22

$44

$72

How much do insurance utilization review jobs pay per hour?

As of Jun 15, 2026, the average hourly pay for insurance utilization review 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 are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are popular job titles related to Insurance Utilization Review jobs in Colorado? For Insurance Utilization Review jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Colorado look for? The top searched job categories for Insurance Utilization Review jobs in Colorado are:
What cities in Colorado are hiring for Insurance Utilization Review jobs? Cities in Colorado with the most Insurance Utilization Review job openings:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Colorado as of June 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $92,477 per year, or $44.5 per hour.
Continued Stay Coordinator

Continued Stay Coordinator

InnovAge

Denver, CO • On-site, Remote

$22.84 - $27.40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 4 days ago

InnovAge rating

6.6

Company rating: 6.6 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

Job description

Responsibilities
The Continued Stay Coordinator is responsible for facilitating and coordinating continued stay eligibility determinations to ensure participants remain eligible for services under applicable regulatory, contractual, and organizational requirements. This role conducts periodic functional eligibility reviews, analyzes clinical and non-clinical information, and collaborates with interdisciplinary teams to support timely, accurate continued stay decisions. The position plays a critical role in regulatory compliance, continuity of care, and audit readiness.
Essential Functions and Responsibilities
  • Facilitate Continued Stay Reviews (CSRs) by making referrals to agencies for the Level of Care (LOC).
  • Serve as case manager until certification is obtained for annual continuation of PACE services.
  • Facilitate continued stay reviews in accordance with federal, state, and program-specific eligibility requirements
  • Conduct periodic functional eligibility reassessments using clinical documentation, assessments, and interdisciplinary input
  • Collect, review, and analyze supporting medical, functional, and psychosocial information to determine continued eligibility
  • Coordinate continued stay review schedules and ensure reviews are completed within required timeframes
  • Prepare and maintain comprehensive eligibility documentation, determinations, and supporting rationale in designated systems
  • Collaborate with interdisciplinary team members (e.g., clinical staff, care coordinators, social services, enrollment, compliance) to support continued stay determinations
  • Identify and escalate potential eligibility risks, gaps, or changes in participant status that may impact continued stay
  • Communicate continued stay outcomes, requirements, and next steps to internal stakeholders and, as appropriate, participants or authorized representatives
  • Ensure compliance with regulatory standards, program contracts, and organizational policies related to continued stay and eligibility
  • Support audits, reviews, and appeals by providing accurate documentation and responding to eligibility inquiries
  • Maintain strict confidentiality of participant information in accordance with HIPAA and organizational standards

Travel: 0% to 2%
Knowledge, Skills, and Abilities
  • Knowledge of continued stay review processes and functional eligibility requirements
  • Familiarity with healthcare regulatory frameworks (e.g., Medicaid, long-term care, or PACE-related eligibility standards)
  • Strong analytical skills with the ability to interpret clinical and functional information
  • High attention to detail and accuracy in documentation and determinations
  • Effective written and verbal communication skills, including explaining eligibility decisions clearly
  • Ability to manage multiple cases, prioritize deadlines, and work independently
  • Proficiency with electronic health records, case management, or eligibility systems
  • Ability to exercise sound judgment and professionalism in complex or sensitive situations

Education and Experience
Required:
  • High school diploma or equivalent
  • Minimum of two years of experience in eligibility determination, continued stay reviews, utilization review, case management, or related healthcare roles

Preferred:
  • Associate's or Bachelor's degree in healthcare administration, social work, nursing, public health, or a related field
  • Experience supporting continued stay, utilization management, or regulatory eligibility reviews in a healthcare setting

Benefits
InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.
InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.
Applicants are considered until the position is filled.
Posted Pay Range
$22.84 - $27.40
Additional Information
Compensation Disclaimer
The pay may vary depending on job related factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity. InnovAge offers a comprehensive benefits package, which includes medical, dental, vision, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, paid time off and company paid holidays.
Attention Florida Applicants
This position requires a background screening through the Florida Care Provider Background Screening Clearinghouse.
For more information, please visit the Clearinghouse Education and Awareness website: https://info.flclearinghouse.com
Agency Disclaimer
InnovAge will not accept unsolicited resumes from search firms for this employment opportunity. Regardless of past practices, all candidates/resumes submitted by search firms to InnovAge by any means without a valid written search agreement in place for that position will be deemed the property of InnovAge and no fee will be paid in the event such candidate is hired by InnovAge.
Fraud Disclaimer
InnovAge is committed to maintaining a safe, transparent, and respectful hiring process for all candidates.
Please be aware that all legitimate email communication regarding InnovAge job opportunities will come exclusively from an email address ending in @innovage.com.
At no point in our hiring process will InnovAge:
  • Request payment from candidates for equipment, background checks, onboarding, training, or any other employment-related purpose
  • Ask for financial information (such as bank account details) before a formal offer and onboarding process is completed through our official systems

If you receive a message claiming to represent InnovAge that does not align with the above, it may be fraudulent. We encourage you to exercise caution and refrain from engaging or sharing personal information.
If you believe you have been contacted by someone misrepresenting InnovAge, please report the activity to HRAnswers@innovage.com or apply directly through our official career site to ensure the opportunity is legitimate.
Your trust matters to us, and we appreciate your interest in joining InnovAge.

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