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Utilization Management Jobs in Colorado (NOW HIRING)

Capital Rx

Formulary Operations Pharmacist

Denver, CO · On-site

$60 - $72/hr

This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates ...

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.

GSK Solutions

RN Case Manager

Grand Junction, CO · On-site

Monitor utilization of healthcare resources and ensure appropriate patient care. * Document case management activities clearly and accurately. * Educate physicians and staff regarding utilization and ...

Pharmacy Careers

Formulary Management Pharmacist

Aurora, CO · On-site

$59.25 - $71.25/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

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Showing results 21-40

All JobsUtilization Management JobsUtilization Management Jobs in Colorado

Utilization Management information

See Colorado salary details

$41K

$94.1K

$171.4K

How much do utilization management jobs pay per year?

As of Sep 7, 2026, the average yearly pay for utilization management 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 is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are the most commonly searched types of Utilization Management jobs in Colorado?

The most popular types of Utilization Management jobs in Colorado are:

What are popular job titles related to Utilization Management jobs in Colorado?

For Utilization Management jobs in Colorado, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in Colorado look for?

The top searched job categories for Utilization Management jobs in Colorado are:

What cities in Colorado are hiring for Utilization Management jobs?

Cities in Colorado with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Colorado as of August 2026, with employment types broken down into 100% Full Time. Highlights an 86% In-person, and 14% Remote job distribution, with an average salary of $94,093 per year, or $45.2 per hour.

Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Color

Denver Health

Denver, CO • On-site

$143K - $237K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 15 days ago

Denver Health rating

7.8

Company rating: 7.8 out of 10

Based on 69 frontline employees who took The Breakroom Quiz

200th of 1,065 rated hospitals

Job description

We are recruiting for a mission-driven Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On Site Requirement) to join our team!
We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something we live every day, for life's journey.
Our Values
Respect | Belonging | Accountability | Transparency
Department
Managed Care Administration
* Must Live in Colorado
* This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week.
Job Summary
The Senior Director of Health Plan Utilization Management is a senior leader for the Denver Health Medical Plan (DHMP) with responsibility for providing strategic and operational leadership for all utilization management functions across the organization. This area has unique regulatory and contractual compliance requirements for each line of business. This role is responsible for ensuring clinically appropriate, cost-effective, and regulatory-compliant medical necessity determinations while supporting high-quality member outcomes and provider collaboration. The Senior Director partners closely with Operations, Network Management, Quality, Compliance, and Finance to align utilization management strategy with organizational goals. In this capacity, the Senior Director oversees multiple teams performing this work. The Director reports to the DHMP Chief Medical Officer and collaborates closely with them to develop, update and implement the DHMP Utilization Management vision and strategy.
Essential Functions:
  • Assures that all staff are appropriately trained on all relevant software programs and applications necessary to perform their job functions. (10%)
  • Participates in presentation of reports to the Operations Team, DHMP Board of Directors, and other bodies, as required. (10%)
  • Attends and participates in Quality Management Committee, DHMP Operations Team meetings, Utilization Management Committee, enterprise Care Coordination meetings and other related meetings and activities as required. (10%)
  • Serves as an issue-related or escalation liaison between Utilization Management and other departments and/or agencies both within DH, contractors and/or plan members. (10%)
  • Oversees the maintenance, development, implementation, and continuous improvement of UM policies and procedures and management of information systems to accomplish UM goals for all contracted populations. (10%)
  • Develops, analyzes, and presents reports on productivity, quality and outcomes. (10%)
  • Ensures DHMP can provide documentation of compliance with contractual and regulatory requirements prior to audit by the State, CMS, DOI, etc. (10%)
  • Develops, implements, and evaluates formal educational activities and follows up on issues identified through educational activities. Brings new knowledge to staff meetings. (10%)
  • Works closely with DHMP Compliance Officer to ensure all DHMP lines of business operational performance meets or exceeds regulatory requirements including, but not limited to, policies and procedures reporting. Acts as a voting member of the DHMP Compliance Committee. (10%)
  • Ensures routine and ad hoc reporting available which may include utilization data by setting (inpatient, outpatient, and Pharmacy), or other special projects supporting the overall goals of DHMP. (10%)

Education:
  • Master's degree required
  • Graduation from an accredited educational program for Nursing or Physician's Assistants required

Work Experience:
  • Seven years of experience in administration in managed care, health plan administration or healthcare provider organizations required AND
  • Minimum of five years of supervisory and management experience required AND
  • 1-3 years Health Plan or healthcare experience with various lines of business including Medicare, Medicaid, CHP, Exchange and/or Commercial Plans required AND
  • 1-3 years Experience in managing vendors required required

Licenses:
Knowledge, Skills and Abilities:
  • Knowledge of regulatory and accreditation standards for health plan or healthcare operations required.
  • Strong program development, analysis, and evaluation skills required.
  • Demonstrated excellence in managing people and processes.
  • Strong leadership skills with ability to engage multidisciplinary clinical and non-clinical teams to solve complex problems.
  • Strong knowledge and experience in utilization principles, concepts, and strategies preferred.
  • Ability to develop and maintain effective relationships with internal and external stakeholders.

* Must Live in Colorado
* This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week.
Shift
Days (United States of America)
Work Type
Regular
Salary
$143,800.00 - $237,300.00 / yr
Benefits
At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you're joining a mission-driven organization that invests in you.
Here is a small list of our benefit programs:
  • Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
  • 100% paid parental leave up to 6 weeks
  • Immediate eligibility for retirement plans with employer contribution up to 9.5%
  • Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
  • Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
  • Free RTD EcoPass (public transportation)
  • Childcare discount programs & exclusive perks on large brands, travel, and more
  • Tuition reimbursement & assistance
  • Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
  • Professional clinical advancement program & shared governance
  • Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
  • National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health
Denver Health is an integrated, high-quality academic healthcare system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.
As Colorado's primary, and essential, safety-net healthcare system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.

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