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Utilization Case Manager Jobs in Colorado (NOW HIRING)

Case Manager I

Denver, CO ยท On-site

$20.50 - $26.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Case Manager I

Las Animas, CO ยท On-site

$17.50 - $22.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Case Manager I

Denver, CO ยท On-site

$20.50 - $26.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Case Manager I

Denver, CO ยท On-site

$20.50 - $26.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Medical Case Manager I

Englewood, CO ยท On-site

$70 - $90/hr

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 ...

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 ...

Medical Case Manager I

Greenwood Village, CO ยท 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 ...

Assists with development of utilization/care management policies and procedures. Minimum ... Case Management experience is preferred. * Certification as a Case Manager is preferred. * Minimum ...

Case Manager I - Forum

Denver, CO ยท On-site

$20.50 - $26.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Case Manager I - CCA

Denver, CO ยท On-site

$20.50 - $26.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Case Manager I - Forum

Denver, CO ยท On-site

$20.50 - $26.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Case Manager I - CCA

Denver, CO ยท On-site

$20.50 - $26.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Case Manager I - Forum

Denver, CO ยท On-site

$20.50 - $26.50/hr

Position Summary The Case Manager I works collaboratively alongside case managers, supervisors ... Manages a caseload of clients with high-service utilization and disabilities including substance ...

Showing results 41-60

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:

Case Manager I

cchrpmc

Denver, CO โ€ข On-site

$20.50 - $26.50/hr

Full-time

Re-posted 7 days ago


Job description

Position Summary

The Case Manager I works collaboratively alongside case managers, supervisors, integrated health team members, and community-based partners across the organization to promote long term solutions for families, children, and individuals experiencing homelessness or who have formerly experienced homelessness. This role is responsible for developing and implementing care plans, coordinating services and resources, monitoring client progress, providing advocacy and support, facilitating referrals to other services, and maintaining case documentation and data collection. Client Care Management and Support Services are grounded in motivational interviewing, stages of change, strengths-based case management, housing support services, recovery focused interventions, cultural responsiveness, and trauma-informed care. This position will focus on delivering outreach services, facilitating referrals and linkages to mainstream services and housing, and providing crisis intervention.

Duties/Responsibilities (Essential Functions)

  • Manages a caseload of clients with high-service utilization and disabilities including substance use and significant primary and behavioral health care needs.
  • Maintain positive and co-working relationships with community partners and health providers.
  • Works under direct supervision, with set department parameters. Works collaboratively within a team and supports collective problem-solving efforts.
  • Support clients with a wrap-around care management model to ensure consistent communication, engagement, and supports clients through crisis or disengagement.
  • Acts as a liaison between internal program management, client referral, and community partners.
  • Respond promptly to crises involving residents, providing de-escalation, support, and appropriate referrals.
  • Work with individuals to develop and implement crisis and safety plans tailored to their specific needs.
  • Mediate conflicts helping to resolve issues and maintain positive relationships.
  • Tracks client data, client engagement, and client outcomes. Focus on individual client outcomes.
  • Transports clients, as needed, using a CCH vehicle or an approved personal vehicle. CCH employees must have access to reliable vehicles outside of CCH fleet. Accompany residents to appointments, meetings, and other necessary engagements to provide support and advocacy. Outreach individuals to assess basic needs, safety, and mental health resource needs.
  • Builds rapport and maintains on-going professional relationships with individuals in need of services to get connected to longer-term care.
  • Assist clients in applying for and securing benefits, such as Social Security, Medicaid, and food assistance.
  • Facilitate referrals to external agencies and coordinate care with other service providers as needed.
  • Contributes to enhancing and ensuring safety by identifying and sharing relevant information related to safety concerns, emergencies, or threats to individuals and others.
  • Stays current on applicable community resource list. Provides resources to community members in appropriate situations.
  • Participates in community collaboration meetings to address barriers faced by clients and advance the Coalitionโ€™s efforts in supporting clients.
  • Attends trainings related to the position with intent to bring on-going training and educational opportunities to team.
  • Ensure timely & accurate recording of all clinical/non-clinical services, communications, and ย ย tasks in the EHR and other systems as required while maintaining complete up-to-date charts and any future upgrades as directed.
  • Performs other job duties as assigned.

Education, Licensure and Certifications

  • High School Diploma or GED required.
  • Bachelorโ€™s degree in Psychology, Social Work, Human Services, Criminal Justice preferred
  • Basic Life Support Certification required within 30 days of employment.
  • Must have and maintain in good standing, a Colorado driverโ€™s license within 30 days of hire (with the exception of SSHC)

Experience

  • 1-2 years of experience working with a diverse population experiencing homelessness, substance use disorders or mental health challenges, particularly those individuals diagnosed with serious and persistent mental illness (SPMI) preferredย 

Job Competencies

  • Excellent interpersonal and communication skills, with the ability to build trusting relationships with residents.
  • Strong understanding of housing support services principles, trauma-informed care, and recovery focused interventions
  • Ability to manage a diverse caseload, prioritize tasks, and work independently while also being a team player.
  • Proficiency in Microsoft Office Suite.
  • Knowledge of local housing resources, benefits programs, and social service agencies preferred.

Physical Demands and Working Conditions
The physical demands and work environment are representative of those that must be met or encountered to successfully perform the essential functions of the job with or reasonable accommodation and without posing a direct threat to safety or health of self or others. In compliance with the Americans with Disabilities Act, CCH provides reasonable accommodation to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the Company.

Physical Demands

  • Exerting up to 30 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
  • Bend or position self to move items from higher place to lower place or vice versa.
  • Sit, stand or be stationary.
  • Talk, hear, converse, communicate, or exchange information.
  • Use of hands and/or fingers in a repetitive motion to handle, pinch, grasp, move, feel, inspect, etc.
  • Walk, ascend, descend on both even and uneven terrain.
  • Vision to include distance, depth perception, peripheral and color.

ย 

Percentage of work time spent on activity โ†’

0% - 24%

25% to 49%

50% to 74%

75% to 100%

SEEING: Must be able to read computer screens and printed documents.

X

HEARING: Must be able to hear well enough to communicate with employees and others.

X

STANDING/WALKING

X

CLIMBING/STOOPING/KNEELING

X

LIFTING/PULLING/PUSHING

X

Working Conditions

  • Works primarily in climate-controlled office environment with frequent interpersonal interactions, occasional work in-home, shelters or other outreach situations as needed. May require time outdoors or in a company or personal vehicle or public transit.ย 
  • Schedule is generally Mโ€“F. Flexibility is required to work outside of the regular schedule when needed.