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Insurance Utilization Reviewer Jobs in Colorado (NOW HIRING)

Sierra Vista

UR Coordinator

Johnstown, CO · On-site

$18 - $25/hr

Sierra Vista is seeking a detail-oriented and knowledgeable Utilization Review (UR) Coordinator to support clinical documentation, insurance authorization processes, and regulatory compliance. This ...

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 ... Life & Disability Insurance - Employer-paid coverage for your peace of mind. * Time Off - Over 4 ...

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 ... Life & Disability Insurance - Employer-paid coverage for your peace of mind. * Time Off - Over 4 ...

Evolent

Field Medical Director, Vascular Surgeon

Denver, CO · On-site

$130 - $140/hr

... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...

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 ...

InnovAge

Continued Stay Coordinator

Denver, CO · On-site

$19.75 - $26.75/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 ...

Incredible Health

Nurse Case Manager (RN)

Parker, CO · On-site

$62K - $101K/yr

Clinical pathway, Navigator, or Utilization Review. * Shift(s) available: day shift and night shift ... Best Places to Work recognition, Community hospital, Cross training, Health Insurance, Level 2 ...

Incredible Health

Nurse Case Manager (RN)

Louisville, CO · On-site

$62K - $101K/yr

Clinical pathway, Navigator, or Utilization Review. * Shift(s) available: day shift and night shift ... Best Places to Work recognition, Community hospital, Cross training, Health Insurance, Level 2 ...

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Insurance Utilization Reviewer information

What are the key skills and qualifications needed to thrive as an Insurance Utilization Reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are some common challenges faced by Insurance Utilization Reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What are Insurance Utilization Reviewers?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
What are popular job titles related to Insurance Utilization Reviewer jobs in Colorado? For Insurance Utilization Reviewer jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Colorado look for? The top searched job categories for Insurance Utilization Reviewer jobs in Colorado are:
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Insurance Utilization Reviewer jobs near you

Utilization Review (UR) Coordinator

Communicarehealth

Johnstown, CO

$46K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago

Job description

Job Address:

4770 Larimer Pkwy Johnstown, CO 80534


New Vista Health and Wellnessis currently recruiting aUtilization Review Coordinator!

WHO WE ARE

The New Vista mission:Inspiring Hope, Restoring Peace of Mind, Healing Lives.At New Vista, our passionate and highly trained team of professionals inspires hope and delivers holistic care to those in need of behavioral health services in a contemporary and healing environment - one that is conducive to providing the life skills needed to regain stability and independence. With a blend of group therapy, clinical treatment, and unique surroundings, our beautiful healthcare centers provide a safe, serene, healing environment for adults and seniors with a variety of complex needs.

Our compassionate team members work in a challenging yet rewarding environment where each person is a part of making direct impact on our patient's lives.

COME JOIN OUR TEAM ASUTILIZATION REVIEW COORDINATOR ATSIERRA VISTA!

Salary: Up to $46K

PERKS AT WORK

Team Members enjoy a variety of perks in working with the NewVista brand company. We offer competitive market wages along with a full, robust package:

Healthcare + Life Balance

  • Medical Packages with Rx - 3 Choices
  • Flexible Spending Accounts (FSA)
  • Dependent Day Care
  • Spending Accounts
  • Health Spending Accounts (HSA) with a company match
  • Dental Care Program - 2 choices
  • Vision Plan
  • Life Insurance Options
  • Accidental Insurances
  • Paid Time Off + Paid Holidays
  • Employee Assistance Programs
  • 401k with a Company Match

Education + Leadership Development

  • Up to $15,000 in Tuition Reimbursements OR Student Loan forgiveness
  • Handle with Care Trainer - Certifications

Recognition + Rewards

  • On the spot recognition
  • Prizes
  • Team Member of the Quarter
  • Team Member of the Year
  • Monthly Celebrations
  • Team Member Recognition Cards

Education

  • High school diploma or GED (Required)
  • Bachelor's Degree in Nursing, Social Work, Mental Health/Behavioral Sciences, or related field preferred.
  • Previous Utilization Review experience in a behavioral healthcare facility preferred.

JOB RESPONSIBILITIES

As Utilization Review Coordinator, you will :

  • Obtain initial authorizations and provide discharge notifications for inpatient and outpatient behavioral health treatment.
  • Coordinate authorization information with third party payors in a timely manner.
  • Complete thorough and accurate documentation in all required systems.
  • Maintain communication system based on documentation and verbal exchange regarding treatment with other UM staff and staff at the facilities as needed.
  • Reports appropriate denial and authorization information to designated resource.
  • Assist UM Specialists in scheduling and following up on results of Peer to Peer requests for physicians and CNP.
  • Provide support to the UM Specialists.

Skills:

  • Ability to multi-task
  • Strong organization skills
  • Strong problem-solving skills
  • Ability to work well independently and as a part of a team

Qualified candidates, apply now for a chance to join our outstanding team as weInspire Hope, Restore Peace of Mind, and Heal Lives.

Apply