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Utilization Case Manager Jobs in Colorado (NOW HIRING)

Delta Health

Case Manager

Delta, CO · On-site

$33.19 - $47.97/hr

Description Position Summary The Case Manager / Utilization Review (UR) is responsible for utilization review, discharge planning, patient advocacy, social services, and documentation review. This ...

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Delta Health

Case Manager

Delta, CO

$18.75 - $24.25/hr

Position Summary The Case Manager / Utilization Review (UR) is responsible for utilization review, discharge planning, patient advocacy, social services, and documentation review. This role evaluates ...

New

Advocate Aurora Health

Case Manager

Aurora, CO

$20.25 - $26.25/hr

Provides case management services related to various levels of health care, finances, housing ... Documents discharge planning interventions and utilization review activity per department and ...

GDIT

Nurse Case Manager

Fort Carson, CO · On-site

Knowledge and skill in using pre-established utilization review criteria recognize and report ... case management practice, outcomes, and organizational/MHS values. CLEARANCE: Ability to obtain and ...

DEVELOPMENTAL PATHWAYS INC

Case Manager - Active

Aurora, CO · On-site

$25.10 - $28.68/hr

As an Active Case Manager, you'll play a vital role in delivering compassionate, person-centered ... utilization of standardized tools * Maintain knowledge of state/ federal regulations, policies, and ...

CVS Health

Case Manager, Registered Nurse

Denver, CO · Remote

$54K - $155K/yr

Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care ...

Corvel

Medical Case Manager I

Greenwood Village, CO · On-site

$63K - $95K/yr

As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...

Incredible Health

Nurse Case Manager (RN)

Aurora, CO

$62K - $101K/yr

Nurse Case Manager (RN). Nurses with experience in any of the following areas are strongly ... Clinical pathway, Navigator, or Utilization Review. * Shift(s) available: day shift * Job types ...

Incredible Health

Nurse Case Manager (RN)

Parker, CO

$62K - $101K/yr

Nurse Case Manager (RN). Nurses with experience in any of the following areas are strongly ... Clinical pathway, Navigator, or Utilization Review. * Shift(s) available: day shift * Job types ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Colorado

Utilization Case Manager information

What is a Utilization Case Manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What does a utilization case manager do?

A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with medical providers and insurance companies. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and clinical knowledge. Their goal is to optimize resource use while maintaining quality patient care.

What jobs pay 10,000 a month without a degree?

Utilization Case Managers typically do not earn $10,000 a month without specialized experience or certifications; most roles in this field pay lower salaries. High-paying jobs that can reach this level without a degree include sales, real estate, or entrepreneurship, often requiring strong skills, networking, and industry knowledge. Some trades, like certain construction or technical roles, may also offer high earnings with experience and certifications rather than formal degrees.

How does a Utilization Case Manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What jobs pay 2000 a day?

Utilization Case Managers typically do not earn $2,000 a day; such high daily earnings are more common in specialized roles like senior executives, certain consulting positions, or high-level medical professionals. Most jobs with high daily pay require advanced skills, certifications, or extensive experience, and earnings can vary based on industry, location, and workload.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative skills, familiarity with medical terminology, and sometimes certification. It provides experience in healthcare settings and can serve as a stepping stone to more advanced medical roles, but it may have limited responsibilities compared to specialized positions.

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

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Colorado? For Utilization Case Manager jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Colorado look for? The top searched job categories for Utilization Case Manager jobs in Colorado are:
What cities in Colorado are hiring for Utilization Case Manager jobs? Cities in Colorado with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you

Case Manager

Delta Health

Delta, CO • On-site

$33.19 - $47.97/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

Job description

Description
Position Summary
The Case Manager / Utilization Review (UR) is responsible for utilization review, discharge planning, patient advocacy, social services, and documentation review. This role evaluates the medical necessity of hospital admissions, ensures appropriate patient status and level of care, and collaborates with physicians to support accurate clinical documentation.
The position works closely with patients, families, providers, hospital departments, payers, and community resources to coordinate care and facilitate safe, timely discharges.
Essential Responsibilities
  • Conduct concurrent reviews of hospital admissions to determine medical necessity and appropriate admission status.
  • Perform ongoing chart and documentation reviews to support regulatory compliance and accurate reimbursement.
  • Collaborate with physicians to ensure documentation accurately reflects patient severity and complexity of care.
  • Interview patients and families to assess discharge planning needs.
  • Develop and coordinate individualized discharge plans utilizing hospital and community resources.
  • Provide psychosocial support, patient advocacy, and education to patients and families.
  • Participate in interdisciplinary care conferences and coordinate care across departments.
  • Complete Social Determinants of Health (SDOH) screenings as required.
  • Present outlier cases to the Utilization Review Committee and attend committee meetings.
  • Assist with denials management, audits, and payer-related issues.
  • Serve as a resource for staff regarding medical necessity, level of care, and discharge planning.
  • Maintain confidentiality and support a positive team environment.

Qualifications
Required
  • Current Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in the State of Colorado.
  • Minimum three (3) years of hospital-based nursing experience.
  • Working knowledge of CMS regulations and medical necessity requirements.
  • Experience with EMR systems, preferably Meditech.
  • Strong communication, organizational, analytical, and problem-solving skills.
  • Ability to prioritize workload, manage multiple tasks, and work independently.
  • Strong interpersonal skills with the ability to effectively collaborate with physicians, staff, patients, and families.

Preferred
  • Experience in utilization review, case management, discharge planning, or care coordination.
  • Knowledge of Milliman Care Guidelines and quality improvement processes.

Why Join Delta Health?
Comprehensive Benefits Package
  • Medical, RX, Dental & Vision - Low premiums with 100% coverage on services provided within the Delta Health system, and no deductibles or co-pays. Includes access to massage therapy, acupuncture, and chiropractic care.
  • Life & Disability Insurance - Employer-paid coverage for your peace of mind.
  • Time Off - Over 4 weeks of paid vacation annually (including sick and personal leave) for full-time staff.
  • Retirement - 403(b) plan with up to a 2% employer match.

Work-Life Balance in a Stunning Location
Located on the Western Slope of the Rocky Mountains, Delta offers an unmatched combination of small-town charm, affordability, and natural beauty. Enjoy year-round outdoor activities such as hiking, skiing, mountain biking, fishing, and exploring the Grand Mesa and surrounding public lands. Whether you're raising a family or looking for work-life balance, Delta provides a safe, friendly community with a slower pace and a high quality of life. Delta is surrounded by the Grand Mesa, Uncompahgre Plateau, and nearby wineries, offering a unique blend of adventure and relaxation.
Delta Health is a county-wide healthcare system with more than 100 years of dedication to serving our community. Our 49-bed hospital and outpatient locations across Delta County are committed providing remarkable care in a healing environment. We operate with the core belief: Excellence. Every Patient. Every Time.
We are an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity or expression, age, national origin, disability, veteran status, or any other protected characteristic

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