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Manager Utilization Management Jobs in Colorado (NOW HIRING)

Capital Rx

Clinical Account Consultant, PBM

Denver, CO · On-site

$140K - $160K/yr

Analyze pharmacy claims, utilization, and drug trend data to surface insights and build evidence-based recommendations across formulary, utilization management, specialty, and clinical programs.

Judi Health

Formulary Operations Pharmacist

Denver, CO · On-site

$60 - $72/hr

This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates ...

Capital Rx

Formulary Operations Pharmacist

Denver, CO · On-site

$60 - $72/hr

This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates ...

Capital Rx

Formulary Operations Pharmacist

Denver, CO · On-site

$60 - $72/hr

This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates ...

Vizient, Inc.

Value Analysis Manager

Centennial, CO · On-site

$88K - $155K/yr

Knowledge of value analysis methodologies, product standardization practices, and utilization management principles. * Ability to analyze clinical, operational, financial, and quality data to support ...

Vizient

Value Analysis Manager

Englewood, CO · Hybrid

$88K - $155K/yr

Knowledge of value analysis methodologies, product standardization practices, and utilization management principles. * Ability to analyze clinical, operational, financial, and quality data to support ...

Atlas OT LLC

Sr. Project Manager

Centennial, CO · On-site

$130K - $160K/yr

Resource and Utilization Management:Manage utilization targets across project managers, engineers, andfield staff. * Business Development and Sales: Supportand drive pursuit strategy for strategic ...

Pharmacy Careers

Remote Clinical Review Pharmacist

Aurora, CO · On-site

$120K - $144K/yr

Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document recommendations and decisions according to health-plan and regulatory requirements. * Participate in ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Colorado

Manager Utilization Management information

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

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

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Colorado? The most popular types of Utilization Management jobs in Colorado are:
What are popular job titles related to Manager Utilization Management jobs in Colorado? For Manager Utilization Management jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Colorado look for? The top searched job categories for Manager Utilization Management jobs in Colorado are:
What cities in Colorado are hiring for Manager Utilization Management jobs? Cities in Colorado with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Colorado as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Utilization Review Registered Nurse : On Site Position

Pioneers Medical Center

Meeker, CO • On-site

$33.50 - $49/hr

Other

Re-posted 8 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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