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Utilization Case Manager Jobs in Colorado (NOW HIRING)

ScionHealth

Case Manager II

Denver, CO · On-site

$43.82 - $55.57/hr

Follows patients throughout the continuum of care and ensures optimum utilization of resources ... of functions of case management, utilization review and management, and discharge planning.

Bestica

Travel RN Case Manager

Grand Junction, CO · On-site

Strong experience with discharge planning, utilization review, care coordination, and interdisciplinary collaboration 299025 RN Case Manager - Full-Time 📍 Grand Junction, CO 📅 Start Date: 08/31 ...

Team Select Home Care

Case Manager

Loveland, CO · On-site

$20.50 - $26.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Colorado Springs, CO

$19.75 - $25.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Denver, CO · On-site

$20.50 - $26.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Loveland, CO · On-site

$20.50 - $26.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Denver, CO · On-site

$20.50 - $26.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Colorado Springs, CO · On-site

$19.75 - $25.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

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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 are the key skills and qualifications needed to thrive as a utilization case manager?

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.

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 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 degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

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 II

ScionHealth

Denver, CO • On-site

$43.82 - $55.57/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 21 days ago

ScionHealth rating

5.6

Company rating: 5.6 out of 10

Based on 49 frontline employees who took The Breakroom Quiz

807th of 898 rated healthcare providers

Job description

Kindred Hospital Denver and Acute Rehabilitation Unit (ARU) is an all-private room 68-bed hospital located on one of Denver's important medical campuses, just east of St. Joseph's Hospital and Presbyterian St. Luke's Medical Center. With 68 long-term acute care hospital (LTACH) beds, we offer the same in depth care you would receive in a traditional hospital, but for an extended recovery period. Our 13-bed ARU is designed for people who have experienced the debilitating effects of an acute injury, impairment or illness and like the LTACH, we partner with your physician and offer 24-hour clinical care seven days a week so you can start your journey to wellness. Our care has touched individuals from the Front Range, the western slopes of Colorado, and throughout the country.
Job Summary
Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
Essential Functions
Care Coordination
  • Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
  • Monitors all areas of patients' stay for effective care coordination and efficient care facilitation.
  • Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
  • Appropriately refers high risk patients who would benefit from additional support.
  • Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
  • Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
  • Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs. Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals.
  • Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients' care throughout the care continuum.

Knowledge/Skills/Abilities/Expectations
  • Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
  • Knowledge of Medicare benefits and insurance processes and contracts.
  • Knowledge of accreditation standards and compliance requirements.
  • Ability to demonstrate critical thinking, appropriate prioritization and time management skills.
  • Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
  • Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
  • Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
  • Approximate percent of time required to travel: 0%
  • Must read, write and speak fluent English.
  • Must have good and regular attendance.
  • Performs other related duties as assigned.

Pay range: $43.82 - $55.57/Hr
ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.
Qualifications
Education
  • Postsecondary (Cert/Diploma/Program Grad) from an accredited school of nursing (Required) And
  • Bachelor's Degree in nursing or social work: BSN, MSN, BSW or MSW (Preferred)

Licenses/Certifications
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of practice Upon Hire (Required) Or
  • LCSW- License Clinical Social Worker LCSW or LSW Upon Hire (Required) Or
  • CSWCM - Social Work Case Manager Certification Upon Hire (Preferred)

Experience
  • 2+ years experience in healthcare setting (Required) And
  • Prior Experience in case management, utilization review, or discharge planning (Preferred)

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