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Manager Optum Utilization Review Jobs in Colorado

Astyra Corporation

Clinical Reviewer

Denver, CO

$35 - $40/hr

Outpatient PT/OT/ST * 3+ years of clinical experience in acute care, behavioral health, or medical-surgical settings. * 2+ years of Utilization Review/Management (UR/UM) or Prior Authorization ...

All Points North

Integrated Care Advisor

Edwards, CO

$60K - $75K/yr

... Utilization & Continuum of Care Management * Assess and recommend appropriate levels of care throughout treatment * Participate in utilization review processes, supporting medical necessity ...

All Points North

Integrated Care Advisor

Edwards, CO · On-site

$60K - $75K/yr

... Utilization & Continuum of Care Management * Assess and recommend appropriate levels of care throughout treatment * Participate in utilization review processes, supporting medical necessity ...

ScionHealth

Case Manager II

Denver, CO · On-site

$43.82 - $55.57/hr

... utilization review and management, and discharge planning. Essential Functions Care Coordination ... Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.

New

GQR Healthcare

Travel RN Case Manager

Grand Junction, CO · On-site

$1.5K - $1.6K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Grand Junction, Colorado Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Hospital ...

New

UnitiMed

RN Case Manager

Glenwood Springs, CO · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

New

Evolent

Physician Reviewer-Radiology (Part Time)

Denver, CO · On-site

$95 - $100/hr

As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ...

Evolent

Physician Reviewer-Radiology (Full-Time)

Denver, CO · On-site

$95 - $96/hr

As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a ... Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ...

InnovAge

RN Case Manager

Pueblo, CO

$86K - $138K/yr

The RN Case Manager actively assists providers and facility staff in managing InnovAge admitted ... and support utilization review and improvement activities. The role aims to optimize positive ...

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Manager Optum Utilization Review information

What does a manager Optum Utilization Review do?

A Manager of Optum Utilization Review oversees a team responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that all reviews comply with regulatory standards, company policies, and clinical guidelines. Managers also collaborate with healthcare providers, monitor team performance, and help implement process improvements to optimize patient outcomes and resource use. Their role is vital in balancing quality patient care with cost-effective service delivery.

How does a manager Optum Utilization Review typically collaborate with clinical and non-clinical teams to ensure effective case management?

As a Manager in Optum Utilization Review, you will regularly coordinate with clinical teams such as nurses, physicians, and case managers to review patient cases for medical necessity and compliance with policies. You’ll also work closely with non-clinical staff, including data analysts and administrative professionals, to streamline workflows and support accurate documentation. Effective collaboration ensures timely decision-making, helps resolve escalated cases, and supports continuous quality improvement initiatives. This role often requires strong communication and leadership skills to align multidisciplinary teams and achieve organizational goals.

What are the key skills and qualifications needed to thrive as a manager Optum Utilization Review, and why are they important?

To thrive as a Manager, Optum Utilization Review, you need a background in healthcare management, clinical expertise (often as an RN or related field), and experience with utilization management processes. Familiarity with utilization review software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) or URAC accreditation is typically required. Strong leadership, analytical thinking, and effective communication skills help you guide teams and collaborate with providers and payers. These competencies are crucial for ensuring compliance, optimizing patient care, and achieving organizational goals in a complex healthcare environment.

What is the difference between Manager Optum Utilization Review vs Utilization Review Nurse?

AspectManager Optum Utilization ReviewUtilization Review Nurse
CredentialsTypically requires a nursing license, certifications in case management or utilization reviewRegistered Nurse (RN) license, certifications in case management or utilization review
Work EnvironmentSupervises teams, manages review processes, collaborates with healthcare providersConducts patient reviews, assesses medical necessity, documents findings
Employer & Industry UsageCommon in health insurance companies, managed care organizations, healthcare providersPrimarily in hospitals, insurance companies, healthcare organizations

The main difference is that the Manager Optum Utilization Review oversees the review process and team management, while the Utilization Review Nurse focuses on conducting individual patient assessments and reviews. Both roles require nursing credentials and knowledge of healthcare policies, but the manager has additional responsibilities in leadership and process oversight.

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

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

What are popular job titles related to Manager Optum Utilization Review jobs in Colorado?

For Manager Optum Utilization Review jobs in Colorado, the most frequently searched job titles are:

What job categories do people searching Manager Optum Utilization Review jobs in Colorado look for?

The top searched job categories for Manager Optum Utilization Review jobs in Colorado are:

What cities in Colorado are hiring for Manager Optum Utilization Review jobs?

Cities in Colorado with the most Manager Optum Utilization Review job openings:

Manager Optum Utilization Review jobs near you
Infographic showing various Manager Optum Utilization Review job openings in Colorado as of August 2026, with employment types broken down into 91% Full Time, 5% Part Time, 2% Temporary, and 2% Contract. Highlights an 86% In-person, 3% Hybrid, and 11% Remote job distribution.

Manager, Medical Utilization and Care Management

Capital Rx

Denver, CO • On-site

$95K - $130K/yr

Other

This job post has expired today. Applications are no longer accepted.

Job description

About Judi Health

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

Position Responsibilities:

  • Provide oversight for vendors conducting utilization management, care management, and clinical operations activities.
  • Oversee vendor execution of utilization reviews, including prospective, concurrent, and retrospective reviews, to ensure medical necessity and appropriate level of care determinations.
  • Monitor vendor review of medical records and treatment plans to support appropriate service utilization, avoid unnecessary or duplicate services, and optimize reimbursement outcomes.
  • Partner with the Medical Director and vendor clinical leadership on complex cases, escalations, policy development, and clinical determinations.
  • Provide oversight of vendor-managed prior authorization, peer-to-peer review, denial, appeal, and notification processes.
  • Ensure vendors complete comprehensive biopsychosocial assessments and health risk assessments (HRAs) in accordance with program requirements.
  • Oversee vendor-led care coordination across the continuum, including transitions of care and discharge planning.
  • Provide oversight of vendor-administered chronic disease and complex case management programs.
  • Monitor vendor documentation practices to support risk adjustment, compliance, and continuity of care.
  • Review utilization trends and vendor performance data to identify quality improvement opportunities and ensure action plans are implemented.
  • Ensure vendor compliance with applicable regulatory and accreditation standards, including URAC and NCQA requirements.
  • Coordinate with vendor interdisciplinary teams, including nurses, social workers, and care coordinators, to promote aligned clinical operations and member outcomes.
  • Promote vendor-delivered care coordination aligned with nursing practice principles and measurable quality, cost, and member experience outcomes.

Required Qualifications:

  • Active unrestricted RN license (BSN preferred)
  • 5+ years of experience in utilization management, care management, or case management
  • 2+ years leadership experience
  • Knowledge of medical necessity reviews, care coordination models, and payer systems

Preferred Qualifications:

  • Certification (CCM, CMGT-BC, HCQM).
  • Experience with Commercial, Medicare and Medicaid population.
  • Experience working with Medical Directors, Vendors, and Health Systems.
  • Knowledge of URAC/NCQA standards.
New York, NY Salary Range
$95,000—$130,000 USD
Denver, CO Salary Range
$95,000—$130,000 USD
Charlotte, NC Salary Range
$95,000—$130,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found athttps://www.judi.health/legal/privacy-policy.

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