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Medical Director Utilization Management Jobs in Colorado

UHS

DIR - UTILIZATION REVIEW / MGMT

Colorado Springs, CO · On-site

$85K - $120K/yr

The Director of Utilization Review is responsible for directing and overseeing the Utilization ... of medical and psychiatric criteria for various levels of care. The ability to effectively ...

Evolent

Field Medical Director, Vascular Surgeon

Denver, CO · On-site

$130 - $140/hr

As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...

Capital Rx

Prior Authorization Systems Pharmacist

Denver, CO · On-site

$60 - $72/hr

... and medical benefit administration on a single, secure platform. By delivering true price ... Works with Director, Utilization Management on other responsibilities, projects, and initiatives as ...

Wellpath

Medical Director

Castle Rock, CO

Overview The Site Medical Director provides clinical leadership at the assigned facility and ... Oversee chronic care clinics, utilization review, and quality improvement initiatives * Collaborate ...

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Medical Director Utilization Management information

See Colorado salary details

$13.7K

$244.3K

$375.4K

How much do medical director utilization management jobs pay per year?

As of Aug 21, 2026, the average yearly pay for medical director utilization management in Colorado is $244,340.00, according to ZipRecruiter salary data. Most workers in this role earn between $208,200.00 and $299,200.00 per year, depending on experience, location, and employer.

What is a medical director utilization management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

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

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a medical director utilization management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

What are popular job titles related to Medical Director Utilization Management jobs in Colorado?

For Medical Director Utilization Management jobs in Colorado, the most frequently searched job titles are:

What job categories do people searching Medical Director Utilization Management jobs in Colorado look for?

The top searched job categories for Medical Director Utilization Management jobs in Colorado are:

What cities in Colorado are hiring for Medical Director Utilization Management jobs?

Cities in Colorado with the most Medical Director Utilization Management job openings:

Medical Director Utilization Management jobs near you

Senior Utilization Management Nurse

Integrated Resources

Denver, CO • On-site

Other

Medical

Re-posted 7 days ago

Job description

Senior Utilization Management Nurse

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Under minimal supervision, provides medical and/or behavioral health utilization management for members of Medical Plan in accordance with the schedule of benefits and network criteria defined by the Plan's various lines of business and Center of Medicare & Medicaid Services ("CMS") regulatory requirements. Completes clinical review to determine whether a request can be approved using nationally recognized criteria such as InterQual or MCG, or requires additional review by the Plan's Medical Director. MINIMUM QUALIFICATIONS: Education: Bachelor's degree in Nursing. A combination of education and experience may be substituted for the B.S.N. requirement. Experience: Typically, three years of medical utilization management experience working with a health insurance plan, hospital, skilled nursing facility, or surgical center. Managed Care experience is highly preferred.

Qualifications

Responsibilities: Facility seeks 2 F/T RN Case Managers for excellent contract working in Managed Care department. Must have BSN, 3 years' experience in medical utilization management, and experience working with a health insurance plan. Managed Care experience is preferred however hospital experience is also considered. Seeking highly skilled individual with experience with InterQual and MCG. Provides medical and/or behavioral health utilization management for members of facility medical plan in accordance with the schedule of benefits and network criteria defined by the Plans various lines of business and Center of Medicare & Medicaid Services.

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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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