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Utilization Care Manager Jobs in Colorado (NOW HIRING)

Care Manager RN

Aurora, CO · On-site

$38.91 - $60.31/hr

Provides focused support to various areas such as utilization management, emergency department, acute, ambulatory and specialty care. Responsibilities: * Demonstrates critical thinking skills when ...

Care Manager RN

Aurora, CO

$38.91 - $60.31/hr

Provides focused support to various areas such as utilization management, emergency department, acute, ambulatory and specialty care. Responsibilities: * Demonstrates critical thinking skills when ...

Care Manager RN

Greeley, CO · On-site

$38.91 - $60.31/hr

Provides focused support to various areas such as utilization management, emergency department, acute, ambulatory and specialty care. Responsibilities: * Demonstrates critical thinking skills when ...

Care Manager RN

Aurora, CO · On-site

$38.91 - $60.31/hr

Provides focused support to various areas such as utilization management, emergency department, acute, ambulatory and specialty care. Responsibilities: * Demonstrates critical thinking skills when ...

Care Manager RN

Greeley, CO · On-site

$38.91 - $60.31/hr

Provides focused support to various areas such as utilization management, emergency department, acute, ambulatory and specialty care. Responsibilities: * Demonstrates critical thinking skills when ...

Care Manager RN

Greeley, CO · On-site

$38.91 - $60.31/hr

Provides focused support to various areas such as utilization management, emergency department, acute, ambulatory and specialty care. Responsibilities: * Demonstrates critical thinking skills when ...

Care Manager RN

Aurora, CO · On-site

$38.91 - $60.31/hr

Provides focused support to various areas such as utilization management, emergency department, acute, ambulatory and specialty care. Responsibilities: * Demonstrates critical thinking skills when ...

Nurse Case Mgr II (US)

Denver, CO · On-site

$79K - $130K/yr

Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any ...

Nurse Case Mgr II (US)

Denver, CO · On-site

$79K - $130K/yr

Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any ...

Showing results 21-40

Utilization Care Manager information

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

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

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What cities in Colorado are hiring for Utilization Care Manager jobs? Cities in Colorado with the most Utilization Care Manager job openings:

RN Care Manager I - PRN

Intermountain Healthcare

Lafayette, CO • On-site

$41.20 - $62.17/hr

Other

Re-posted yesterday


Intermountain Health rating

7.2

Company rating: 7.2 out of 10

Based on 842 frontline employees who took The Breakroom Quiz

349th of 887 rated healthcare providers


Job description

RN Hospital Care Manager I

The RN Hospital Care Manager I delivers comprehensive care management services to designated patients, leveraging clinical expertise for screenings, assessments, and evaluations. This role involves developing and implementing patient-centered care plans with shared goals and tailored interventions. The Care Manager collaborates seamlessly with patients, families/caregivers, healthcare providers, payers, community-based providers, and other stakeholders to ensure efficient, effective, and patient-focused care management. This position spans various departments, including both Inpatient and Outpatient areas.

Essential Functions
  • Assessment: Identifies patients using screening criteria and conduct comprehensive evaluations.
  • Care Planning: Develops, adjusts, and coordinates care plans to address medical and social needs.
  • Patient Support: Guides self-management using motivational interviewing and coaching.
  • Education & Advocacy: Provides education to healthcare teams and patients, advocate for patient rights, and support self-care.
  • Collaboration: Works with multidisciplinary teams to ensure timely, high-quality care.
  • Process Improvement: Leads initiatives to enhance care transitions and policy adherence.
  • Advanced Care Planning: Provides Goals of Care education for informed decision-making.
  • Data Analysis & Compliance: Tracks key metrics, analyze trends, and ensure regulatory compliance.
Skills
  • Assessment
  • Care Planning
  • Motivational Interviewing
  • Critical Thinking
  • Time Management
  • Customer Service
  • Patient Education
  • Communication
  • Prioritization
Minimum Qualifications
  • Current Registered Nurse (RN) license in state of practice.
  • Bachelor of Science in Nursing (BSN) from an accredited institution (degree verification required). RNs hired or promoted into this role must obtain their BSN within four (4) years of their hire or promotion date. If there is an existing education agreement, that agreement will take precedence.
  • Demonstrated clinical nursing experience in an inpatient hospital setting, and familiarity with hospital patient-related terminology and processes.
  • Demonstrated understanding of disease management including treatment, length of stay, identifying barriers to delivery of care and any variation.
Preferred Qualification
  • Case Management Certification
  • Demonstrated experience in case management, utilization review, value-based care, and/or discharge planning.
  • Basic computer skills, including proficiency in word processing and spreadsheet software. Intermediate knowledge of word processing and Excel software.
Physical Requirements
  • Ongoing need for employee to see and read information, labels, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
  • Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
  • Manual dexterity of hands and fingers to manipulate complex and delicate supplies and equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.
  • Mental stamina and flexibility- ability to handle high stress situations, make quick decisions, and manage multiple tasks simultaneously.
  • For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing, and reading signs, traffic signals, and other vehicles.

Location: Good Samaritan Hospital

Work City: Lafayette

Work State: Colorado

Scheduled Weekly Hours: 0

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$41.20 - $62.17

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.


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