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Urac Jobs in Colorado (NOW HIRING)

WELLDYNE

Clinical Operations Pharmacist

Centennial, CO · On-site

$99K - $129K/yr

URAC, ACHC * Knowledge of all pharmacy software applications * Knowledge of e-mail, fax transmission and copy equipment * Ability to assist in the completion and presentation of clinical programs to ...

WellDyne

Clinical Operations Pharmacist

Centennial, CO · On-site

$99K - $129K/yr

URAC, ACHC * Knowledge of all pharmacy software applications * Knowledge of e-mail, fax transmission and copy equipment * Ability to assist in the completion and presentation of clinical programs to ...

WELLDYNE

Clinical Operations Pharmacist

Centennial, CO · On-site

$99 - $129/hr

URAC, ACHC * Knowledge of all pharmacy software applications * Knowledge of e-mail, fax transmission and copy equipment * Ability to assist in the completion and presentation of clinical programs to ...

Capital Rx

Formulary Operations Pharmacist

Denver, CO · On-site

$60 - $72/hr

Leadsformulary change processes within URAC/NCQA/CMS guidelines * SupportsPharmacy and Therapeutics (P&T) committee items, as required * Maintainsand updatesthe Rx pharmaceutical pipeline,development ...

Enlyte

Medical Field Case Manager

Denver, CO · On-site

$71K - $85K/yr

URAC-recognized certification in case management preferred (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC). * Travel: Must have reliable transportation and be able to travel to and ...

Enlyte

Medical Field Case Manager

Thornton, CO · On-site

$75K - $83K/yr

URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC) preferred. * Travel: Must have reliable transportation and be able to travel to and ...

Bloom Hospice

Director of Payor Relations

Lakewood, CO · On-site

$105 - $135/hr

Maintain provider credentialing files in compliance with NCQA, URAC, Joint Commission, and payer-specific standards. * Serve as the primary organizational contact for payer credentialing departments ...

Enlyte

Medical Field Case Manager

Thornton, CO · On-site

$75K - $83K/yr

URAC-recognized certification in case management (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC) preferred. * Travel: Must have reliable transportation and be able to travel to and ...

Enlyte

Medical Field Case Manager

Denver, CO · On-site

$71K - $85K/yr

URAC-recognized certification in case management preferred (CCM, CDMS, CRC, CRRN or COHN, COHN-S, RN-BC, ACM, CMAC, CMC). * Travel: Must have reliable transportation and be able to travel to and ...

Capital Rx

Supervisor, Appeals Pharmacist

Denver, CO · On-site

$128K - $160K/yr

Participates in the quality improvement committee and supports quality improvement projects as required by URAC (5-10% of time) * Work with business and clinical partners as needed * Ability to work ...

Elevance Health

Medical Director Associate

Arvada, CO · On-site

$120 - $225/hr

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving ...

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All JobsUrac JobsUrac Jobs in Colorado

Urac information

What is a URAC?

URAC stands for Utilization Review Accreditation Commission, which is an independent, nonprofit organization that accredits healthcare organizations. URAC develops evidence-based standards to ensure quality, accountability, and consumer protection in healthcare. Accreditation from URAC is often required for organizations providing health plans, case management, pharmacy benefit management, and other healthcare services. The process involves rigorous evaluation and continuous improvement to promote best practices in healthcare operations.

What are the key skills and qualifications needed to thrive as a URAC Accreditation Specialist, and why are they important?

To thrive as a URAC Accreditation Specialist, you need a thorough understanding of healthcare compliance, quality assurance, and regulatory standards, often supported by a background in healthcare administration or nursing. Familiarity with URAC standards, accreditation management systems, and quality improvement tools is typically required. Strong attention to detail, analytical thinking, and effective communication skills help ensure successful navigation of complex requirements and collaboration with stakeholders. These skills and qualifications are crucial for maintaining accreditation, supporting organizational excellence, and ensuring adherence to industry best practices.

What is the difference between Urac vs Radiologic Technologist?

AspectUracRadiologic Technologist
CredentialsTypically requires certification or licensing specific to the roleRequires ARRT certification or state licensure
Work EnvironmentHospitals, clinics, diagnostic imaging centersHospitals, outpatient clinics, diagnostic labs
Industry UsageUsed mainly in healthcare settings for diagnostic proceduresCommonly employed in medical imaging and radiology departments
Search & Comparison IntentOften compared for roles in diagnostic imagingRelated but broader role in radiology services

While both Urac and Radiologic Technologists work in healthcare settings involving diagnostic imaging, Urac roles are often more specialized or specific to certain procedures, whereas Radiologic Technologists have a broader scope in medical imaging and radiology services. Understanding these differences helps in choosing the right career path or job search focus.

What are popular job titles related to Urac jobs in Colorado?

For Urac jobs in Colorado, the most frequently searched job titles are:

What job categories do people searching Urac jobs in Colorado look for?

The top searched job categories for Urac jobs in Colorado are:

Urac jobs near you
Infographic showing various Urac job openings in Colorado as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 20% Part Time, and 3% Contract. Highlights an 64% Physical, 3% Hybrid, and 33% 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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