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Pediatric Utilization Review Jobs in Colorado (NOW HIRING)

CHI Health at Home

OBGYN Physician

Fort Morgan, CO · On-site

$406K/yr

... pediatrics, and acute inpatient care, as well as a multitude of subspecialists across our specialty ... peer review, utilization review, and serve on medical staff committees as assigned to enhance ...

Dignity Physician Careers

OBGYN Physician

Fort Morgan, CO · On-site

$406K/yr

... peer review, utilization review, and serve on medical staff committees as assigned to enhance ... pediatrics, and acute inpatient care, as well as a multitude of subspecialists across our specialty ...

Dignity Physician Careers

OBGYN Physician

Fort Morgan, CO · On-site

$406K/yr

... peer review, utilization review, and serve on medical staff committees as assigned to enhance ... pediatrics, and acute inpatient care, as well as a multitude of subspecialists across our specialty ...

CommonSpirit Health

OBGYN Physician

Fort Morgan, CO · On-site

$406K/yr

... peer review, utilization review, and serve on medical staff committees as assigned to enhance ... pediatrics, and acute inpatient care, as well as a multitude of subspecialists across our specialty ...

St Elizabeth Hospital

OBGYN Physician

Fort Morgan, CO

$406K/yr

... peer review, utilization review, and serve on medical staff committees as assigned to enhance ... pediatrics, and acute inpatient care, as well as a multitude of subspecialists across our specialty ...

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All JobsPediatric Utilization Review JobsPediatric Utilization Review Jobs in Colorado

Pediatric Utilization Review information

What is pediatric utilization review?

Pediatric utilization review is a process in healthcare where specialists assess the necessity, appropriateness, and efficiency of medical services provided to children. The goal is to ensure that pediatric patients receive the right care at the right time, while avoiding unnecessary treatments or procedures. Utilization review professionals review medical records, treatment plans, and insurance information to make informed decisions about coverage and care. This process helps control healthcare costs and maintain high standards of care for young patients.

What are some common challenges faced by pediatric utilization review professionals, and how are they addressed?

Pediatric utilization review professionals often encounter challenges such as balancing the need for cost-effective care with advocating for the unique clinical needs of children. They must navigate complex insurance guidelines while collaborating closely with physicians, case managers, and families to ensure children receive appropriate and timely care. Staying updated on evolving pediatric treatment protocols and regulatory requirements is also essential. Strong communication skills and a thorough understanding of pediatric standards help address these challenges and promote positive patient outcomes.

What are the key skills and qualifications needed to thrive as a pediatric utilization review nurse, and why are they important?

To excel as a Pediatric Utilization Review nurse, you need a solid clinical background in pediatrics, a current RN license, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and industry certifications like Certified Case Manager (CCM) are often required. Strong analytical skills, attention to detail, and effective communication help you collaborate with healthcare teams and advocate for appropriate care. These competencies ensure that pediatric patients receive necessary, cost-effective treatment while maintaining compliance with regulatory standards.

What is the difference between Pediatric Utilization Review vs Pediatric Case Manager?

AspectPediatric Utilization ReviewPediatric Case Manager
CredentialsTypically requires nursing or healthcare-related certificationsRequires nursing, social work, or healthcare certifications
Work EnvironmentReviewing medical records and insurance claims, often remotely or in officeDirect patient interaction, coordinating care, often in clinical or community settings
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, clinics, community health agencies

While both roles focus on pediatric healthcare, Pediatric Utilization Review primarily involves evaluating medical necessity and insurance claims, whereas Pediatric Case Managers coordinate ongoing patient care and support families directly. Understanding these differences helps in choosing the right career path or job search focus.

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

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

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

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

What cities in Colorado are hiring for Pediatric Utilization Review jobs?

Cities in Colorado with the most Pediatric Utilization Review job openings:

Pediatric Utilization Review jobs near you
Infographic showing various Pediatric Utilization Review job openings in Colorado as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Health Information Management Associate - Pediatric Healthcare

Denver, CO • On-site

Care Options for Kids
See more jobs at Care Options for Kidsexternal

$20 - $22/hr

Full-time

Medical, Dental, Vision, Life, PTO

Posted 23 days ago

Job description

Care Options for Kids connects leading pediatric specialists with families to provide best-in-class pediatric therapy, nursing, and school-based services. We seamlessly integrate into children’s lives by bringing individualized care to children where they live, work, and play.

Our pediatric specialists are committed to providing high-quality pediatric services that help children and families live their best lives. We empower our community of clinicians to meet children where they are by providing the support and resources necessary to decrease administrative burdens. This focus allows our clinicians to obtain optimal work-life balance.
We are seeking a collaborative and resourceful Health Information Management (HIM) Associate who is organized, self-motivated, and solution-focused. If you have a positive attitude, strong work ethic, and superb customer service skills, this is the job for you! 

    What you’ll be doing:

    • Demonstrate customer service excellence in every encounter
    • Ensure protected Health Information (PHI) remains confidential and is accurately entered in our Electronic Medical Records (EMR)
    • Manage outstanding documents that need to be signed by ordering physicians
    • Responsiveness to answer questions from families, healthcare providers, and clinicians regarding patient records and orders
    • Document all coordination of care and communications accurately and thoroughly in the Electronic Medical Records (EMR) to assure the highest standard of compliance with home health regulations
    • Work closely in conjunction with other departments to ensure positive clinical outcomes for patients
    • Audit records for completeness and quality assurance
    • Participate, as requested, in in-service education, continuing education, utilization review and QAPI programs
    • Other duties as assigned. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change
    • Fluency in both Spanish and English (written and spoken)

    What you need to have:

    • High school diploma
    • Two  years of experience in the healthcare industry required
    • Ability to read and interpret physician's orders, notes and clinical documentation
    • Strong knowledge of medical terminology
    • Must have experience entering data, sorting and formatting cells in Excel

    What we Offer:

    • Full-time, 40 hours per week 
    • Leading Compensation and Benefits Package
    • Medical, Dental, Vision, Life Insurance, and more!
    • Paid Time Off (PTO)

    Wage: $20 - $22 an hour, Compensation dependent on experience.

    If you are the best at what you do, and are ready to work with an innovative, positive and supportive organization, please contact us today.

    Location: Glendale, CO
    Care Options for Kids is an equal opportunity employer. The Equal Employment Opportunity Policy of Care Options for Kids is to provide a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religion, national origin, gender, sexual orientation, age, marital status or disability. Care Options for Kids hires and promotes individuals solely on the basis of their qualifications for the job to be filled. Solace believes that associates should be provided with a working environment which enables each associate to be productive and to work to the best of his or her ability. We do not condone or tolerate an atmosphere of intimidation or harassment based on race, color, religion, national origin, gender, sexual orientation, age, marital status or disability. We expect and require the cooperation of all associates in maintaining a discrimination and harassment-free atmosphere.