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Utilization Management Nurse Jobs in Colorado (NOW HIRING)

UCHealth

Utilization Management RN

Aurora, CO · On-site

$38.91 - $60.31/hr

State licensure as a Registered Nurse (RN). 3 years of relevant experience. Preferred: 3 years of utilization or case management experience. * BLS through the American Heart Association or the ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Colorado Springs, CO · On-site

$85K - $120K/yr

State of Colorado licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse Basic Life Support ... Provides Utilization Management consultations to UM department and other hospital departments as ...

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UHS

DIR - UTILIZATION REVIEW / MGMT

Colorado Springs, CO · On-site

State of Colorado licensure as LLP, LPC, LLPC LMSW, LLMSW, or Registered Nurse Basic Life Support ... Provides Utilization Management consultations to UM department and other hospital departments as ...

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All JobsUtilization Management Nurse JobsUtilization Management Nurse Jobs in Colorado

Utilization Management Nurse information

See Colorado salary details

$41K

$94.1K

$171.4K

How much do utilization management nurse jobs pay per year?

As of Aug 16, 2026, the average yearly pay for utilization management nurse in Colorado is $94,093.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,800.00 and $109,900.00 per year, depending on experience, location, and employer.

What are some common challenges a utilization management nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

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

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What is a utilization management nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

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

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization management nurse do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

More about Utilization Management Nurse jobs

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Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Colorado as of August 2026, with employment types broken down into 75% Full Time, 15% Part Time, and 10% Contract. Highlights an 100% In-person job distribution, with an average salary of $94,093 per year, or $45.2 per hour.

Senior Utilization Management Nurse

Careers Integrated Resources Inc

Denver, CO • On-site

Other

Medical

Posted 5 days ago

Job description

Senior Utilization Management Nurse

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Under minimal supervision, provides medical and/or behavioral health utilization management for members of Medical Plan in accordance with the schedule of benefits and network criteria defined by the Plan's various lines of business and Center of Medicare & Medicaid Services ("CMS") regulatory requirements. Completes clinical review to determine whether a request can be approved using nationally recognized criteria such as InterQual or MCG, or requires additional review by the Plan's Medical Director. MINIMUM QUALIFICATIONS: Education: Bachelor's degree in Nursing. A combination of education and experience may be substituted for the B.S.N. requirement. Experience: Typically, three years of medical utilization management experience working with a health insurance plan, hospital, skilled nursing facility, or surgical center. Managed Care experience is highly preferred.

Responsibilities: Facility seeks 2 F/T RN Case Managers for excellent contract working in Managed Care department. Must have BSN, 3 years' experience in medical utilization management, and experience working with a health insurance plan. Managed Care experience is preferred however hospital experience is also considered. Seeking highly skilled individual with experience with InterQual and MCG. Provides medical and/or behavioral health utilization management for members of facility medical plan in accordance with the schedule of benefits and network criteria defined by the Plans various lines of business and Center of Medicare & Medicaid Services.

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