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Insurance Utilization Reviewer Jobs in Colorado (NOW HIRING)

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 ...

New

Incredible Health

Nurse Case Manager (RN)

Denver, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Broomfield, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Aurora, 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)

Superior, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Arvada, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Centennial, 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)

Aurora, 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)

Littleton, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Louviers, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Niwot, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Denver, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Aurora, 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)

Boulder, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Littleton, 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 ...

New

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)

Littleton, 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 ...

New

Incredible Health

Nurse Case Manager (RN)

Niwot, 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 ...

New

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All JobsInsurance Utilization Reviewer JobsInsurance Utilization Reviewer Jobs in Colorado

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:
What cities in Colorado are hiring for Insurance Utilization Reviewer jobs? Cities in Colorado with the most Insurance Utilization Reviewer job openings:
Insurance Utilization Reviewer jobs near you
Nurse Case Manager (RN)

Nurse Case Manager (RN)

Incredible Health

Louisville, CO • On-site

$62K - $101K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

New

Job description

Hospitals on Incredible Health are actively hiring and accepting applications in the Louisville, CO area for the following position: Nurse Case Manager (RN). Nurses with experience in any of the following areas are strongly encouraged to apply: Clinical pathway, Navigator, or Utilization Review.
  • Shift(s) available: day shift and night shift
  • Job types available: full time and part time
  • Employer features: Best Places to Work recognition, Community hospital, Cross training, Health Insurance, Level 2 trauma center, Level 3 trauma center, Life Insurance, Magnet recognized, Nurse self-care program , Offers sign on bonus, PTO, Retirement Plan
Qualifications:
  • Bachelor of Science in Nursing (BSN) or higher educational attainment from an accredited program
  • Active and unencumbered Registered Nurse license
  • 1+ years experience in case management, preferably within a healthcare or hospital setting
  • Exceptional interpersonal and communication skills, both written and verbal, to effectively collaborate with medical professionals, patients, and family members
  • Proficiency in electronic health records (EHR) software
Responsibilities:
  • Conduct comprehensive assessments of patients, including their medical history, medication, treatment plans, and psychosocial needs
  • Collaborate closely with healthcare providers, patients, and families to develop and implement individualized care plans
  • Monitor and evaluate patient progress, adjusting care plans as needed and communicating any changes to the healthcare team
  • Serve as the main point of contact between the patient and healthcare providers, ensuring seamless communication and care coordination
  • Maintain up-to-date records and case notes, adhering to all confidentiality and compliance standards
Benefits:
  • Healthcare coverage: Medical, Dental, Vision
  • 401K
  • Paid Time Off
  • Tuition Assistance
Salary: $62,030 to $101,547 /year

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