ZipRecruiter

Log In

1

Utilization Management Clinical Analyst Jobs in Colorado

Grand River Health Main Campus

Clinical Analyst IT

Rifle, CO · On-site

$26.73 - $50.82/hr

Ideal for someone who enjoys problem-solving, managing projects, and bringing both structure and ... Experience with quality improvement (QI) and utilization review (UR) processes, including use of QI ...

Grand River Health Main Campus

Clinical Analyst IT

Rifle, CO · On-site

$26.73 - $50.82/hr

Ideal for someone who enjoys problem-solving, managing projects, and bringing both structure and ... Experience with quality improvement (QI) and utilization review (UR) processes, including use of QI ...

Capital Rx

Clinical Account Consultant, PBM

Denver, CO · On-site

$140K - $160K/yr

Analyze pharmacy claims, utilization, and drug trend data to surface insights and build evidence-based recommendations across formulary, utilization management, specialty, and clinical programs.

next page

Showing results 1-20

All JobsUtilization Management Clinical Analyst JobsUtilization Management Clinical Analyst Jobs in Colorado

Utilization Management Clinical Analyst information

How does a utilization management clinical analyst typically collaborate with clinical and administrative teams to ensure optimal patient care?

A Utilization Management Clinical Analyst works closely with both clinical staff, such as nurses and physicians, and administrative teams to review patient cases and ensure that treatments and services are medically necessary and align with payer guidelines. This role often involves participating in interdisciplinary meetings, communicating findings and recommendations, and helping to develop or refine care protocols. Effective collaboration is essential to balance quality patient care with cost efficiency, and analysts regularly provide feedback and support to improve clinical workflows and documentation.

What are the key skills and qualifications needed to thrive as a utilization management clinical analyst?

To thrive as a Utilization Management Clinical Analyst, you need a solid background in healthcare, strong analytical abilities, and credentials such as RN or LPN licensure or relevant clinical certifications. Familiarity with utilization management software, electronic health records (EHRs), and claims processing systems is typically required. Excellent communication, critical thinking, and attention to detail are soft skills that help you collaborate effectively and make sound clinical determinations. These competencies are crucial for ensuring the appropriate use of medical resources, maximizing patient outcomes, and maintaining regulatory compliance.

What does a utilization management clinical analyst do?

A Utilization Management Clinical Analyst reviews and analyzes medical records, claims, and treatment plans to ensure that healthcare services provided to patients are medically necessary and cost-effective. They work with healthcare providers, insurance companies, and patients to evaluate the appropriateness of medical care based on established guidelines and policies. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulatory standards.

What is the difference between Utilization Management Clinical Analyst vs Utilization Review Nurse?

AspectUtilization Management Clinical AnalystUtilization Review Nurse
CredentialsHealthcare degree, certifications like CCM or CUCRegistered Nurse (RN), state licensure, certifications like CCM
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, insurance companies, outpatient facilities
Employer & IndustryHealth insurance providers, managed care organizationsHospitals, insurance companies, healthcare facilities
Common Search & ComparisonUtilization Management Clinical Analyst vs Utilization Review Nurse

The main difference between a Utilization Management Clinical Analyst and a Utilization Review Nurse lies in their focus and credentials. Clinical Analysts often have healthcare degrees and certifications like CCM, working primarily in insurance or managed care settings. Utilization Review Nurses are registered nurses with licensure, working in hospitals or outpatient facilities. Both roles involve reviewing medical necessity, but their work environments and professional backgrounds differ.

What are popular job titles related to Utilization Management Clinical Analyst jobs in Colorado? For Utilization Management Clinical Analyst jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Utilization Management Clinical Analyst jobs in Colorado look for? The top searched job categories for Utilization Management Clinical Analyst jobs in Colorado are:
Utilization Management Clinical Analyst jobs near you
Infographic showing various Utilization Management Clinical Analyst job openings in Colorado as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Registered Nurse - Utilization Management (RN-UM)

Le CYR Consulting

Colorado Springs, CO • On-site

Other

Re-posted 20 days ago

Job description

Job Title:Registered Nurse - Utilization Management (RN-UM)
Location: Colorado Military Health System (CMHS), Fort Carson, CO, 80913
Tentative Start Date: December 1, 2025
Work Schedule: Monday-Friday, 8-hour shifts between 0600-1700, excluding federal holidays
Qualifications:
  • Education: Graduate of an accredited school of nursing (BSN preferred).
  • Experience:
    • Minimum of 1 year of Utilization Review/Management experience.
    • Minimum of 3 years of clinical nursing experience.
    • Experience with TRICARE and military healthcare systems is highly desirable.
  • License/Certification: Current, full, active, unrestricted RN license in a U.S. jurisdiction; BLS certification required.
  • Other Requirements: Must be a U.S. Citizen; excellent analytical, communication, and organizational skills.
Documents Required for Submission:
  • Updated Resume (With all gaps explained)
  • Current, full, active, unrestricted license as a Registered Nurse in any U.S. state or territory.
  • Basic Life Support (BLS) certification.
Responsibilities:
  • Conduct utilization management reviews to ensure healthcare services are medically necessary, appropriate, and cost-effective.
  • Act as a liaison with providers, referral centers, and TRICARE contractors to ensure patients receive care at the appropriate level and location.
  • Apply clinical knowledge to review medical necessities for specialty referrals, inpatient admissions, and outpatient services.
  • Prepare and analyze reports on utilization data and healthcare trends to identify inefficiencies or over/under-utilization.
  • Identify high-cost or complex cases, collaborating with case managers and providers to optimize patient care planning.
  • Ensure patient care complies with TRICARE access-to-care standards and DHA utilization policies.
  • Educate providers and staff on referral management processes and utilization criteria.
  • Support process improvement initiatives to enhance referral and utilization management across the CMHS.
  • Maintain accurate documentation of all utilization management activities in EHR systems.
  • Protect patient confidentiality and comply with HIPAA and DoD privacy requirements.

Apply