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Remote Utilization Review Manager Jobs in Colorado

ERC Pathlight

Utilization Review Manager

Denver, CO · On-site +1

$93K - $117K/yr

As a Manager, Utilization Review, you will hire, evaluate, and supervise Utilization Review ... This position is posted as remote; however, per company policy, candidates residing within a ...

UCHealth

Utilization Management RN

Aurora, CO · On-site +1

$38.91 - $60.31/hr

... remote option Summary: * Ensures that services are delivered and documented in a manner that ... Reviews admissions and service requests within assigned unit for prospective, concurrent, and ...

CVS Health

Case Manager, Registered Nurse

Denver, CO · Remote

$54K - $155K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

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Remote Utilization Review Manager information

What are some common challenges faced by a Remote Utilization Review Manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

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

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What is a Remote Utilization Review Manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

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

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.
What are the most commonly searched types of Remote Utilization Review jobs in Colorado? The most popular types of Remote Utilization Review jobs in Colorado are:
What are popular job titles related to Remote Utilization Review Manager jobs in Colorado? For Remote Utilization Review Manager jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Manager jobs in Colorado look for? The top searched job categories for Remote Utilization Review Manager jobs in Colorado are:
Remote Utilization Review Manager jobs near you

Utilization Review Manager

ERC Pathlight

Denver, CO • On-site, Remote

$93K - $117K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

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

Job description

Who We Are

At ERC Pathlight, we're on a mission to change lives—and we're looking for people who feel called to do the same.

As one of the nation's leading treatment providers for eating disorders and mood, anxiety, and trauma-related conditions, we bring innovative, evidence-based, and deeply compassionate care to patients across the country. With multiple locations nationwide and extensive virtual programming, we meet patients exactly where they are and help them move toward lasting recovery.

Founded in 2008 by renowned psychiatrists and psychologists, ERC Pathlight now supports more than 6,000 patients each year. And as the need for world-class mental health care continues to rise, our commitment is stronger than ever: to expand access, elevate the standard of care, and empower every patient to rebuild their life with dignity and hope.

Why Join Us

When you join ERC Pathlight, you become part of a team that shows up every day to make a real difference. You'll work alongside passionate clinicians, dedicated support staff, and mission-driven leaders who believe in collaboration, growth, and doing the right thing—always.

Here, your work matters. Your ideas matter. You matter.

If you're energized by purpose, motivated by impact, and ready to help transform the future of mental health treatment, you belong here.

Come build hope. Come save lives. Come grow with us.

What You'll Be Doing:

As a Manager, Utilization Review, you will hire, evaluate, and supervise Utilization Review Specialists and oversee Utilization Review operations. This role coordinates with Clinical Managers and Directors, Physicians, Business Office, and Managed Care Organizations to assure the smooth operation of Utilization Review functions and the provision of optimal patient care.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Clinically supervises teammates in 1:1 and group settings; provides in-moment assistance on escalated issues. Provides oversight to assigned team by supervising, guiding, and directing employees to be effective team members. Ensures that everyone is equipped with the right skills, tools, and talents necessary for executing their duties. Using the established people processes (performance, development, succession, and career) to ensure that the team's level of performance and capabilities meet current and future standards.
  • Advocates for optimal patient care in clinical care determination reviews by proactively reviewing and synthesizing the medical record for discussion with licensed mental health counselors and social workers and RNs at managed care organizations
  • Liaison with regional management teams to discuss clinical issues and facilitate solutions to situations that involve the UR process
  • Oversees regional caseload allocation
  • Attends treatment team meetings to share information and represent UR department; shares clinical documentation quality concerns

Education Requirements:

  • Graduate Degree - Master's degree in psychology, counseling or social work. Alternatively, a bachelor's in Nursing

License and Certification Requirements

  • RN, IF nurse (Required)
  • Full clinical licensure, if mental health. (Required)

Knowledge, Skills and Abilities:

  • 4 to 6 years Utilization review experience (Required)
  • 2 years post-degree mental health experience in direct patient care (Required)
  • 2 years management experience (Preferred)
  • Willingness to work occasional night/weekends

Location & Schedule:

This position is posted as remote; however, per company policy, candidates residing within a 35‑mile radius of ZIP code 80230 will be required to follow a hybrid schedule, even if they applied to the remote posting.
  • Remote: Mondays and Fridays
  • On-site in our Denver Office: Tuesdays, Wednesdays, and Thursdays

The compensation range for this position is based upon candidate experience and market expectations.

Colorado pay range
$93,000—$117,000 USD

What We Offer

At ERC Pathlight, caring for people is our mission and that begins with caring for our own team. Your well-being matters, and our benefit program is designed to support every part of your life.

We offer competitive compensation; comprehensive medical, dental, and vision coverage; generous Paid Time Off; Parental Leave benefits; Retirement benefits; and tuition reimbursement to help you continue growing in your career.

We also recognize that mental health is part of every person's experience. That's why we strive to create a workplace where you feel supported, seen, and encouraged—personally, professionally, and at home.

When you thrive, you can do your best work. And your best work changes lives.