The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans effectively ...
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans effectively ...
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 ...
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 ...
Payer Utilization Management & Business Integration, Senior Associate
Denver, CO · On-site
$77K - $202K/yr
Industry/Sector Health Services Specialism Operations Management Level Senior Associate & Summary At PwC, our people in operations consulting specialise in providing consulting services on optimising ...
Payer Utilization Management & Business Integration, Senior Associate
Denver, CO · On-site
$77K - $202K/yr
Industry/Sector Health Services Specialism Operations Management Level Senior Associate & Summary At PwC, our people in operations consulting specialise in providing consulting services on optimising ...
Utilization Review Coordinator
Steamboat Springs, CO · On-site
$63K - $85K/yr
Utilization Review Manager Job Category: Salaried | Exempt | Full-Time Salary Range: $63,000-$85,000 per year (depending on experience and licensure) Job Site: Remote Schedule: Business hours, with ...
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Utilization Review Coordinator
Steamboat Springs, CO · On-site
$63K - $85K/yr
Utilization Review Manager Job Category: Salaried | Exempt | Full-Time Salary Range: $63,000-$85,000 per year (depending on experience and licensure) Job Site: Remote Schedule: Business hours, with ...
Clinical Quality Specialist
Denver, CO · On-site
$72K - $82K/yr
What you'll do Utilization Management & Review * Conduct prospective, concurrent, and retrospective utilization reviews to assess medical necessity, treatment appropriateness, and level of care
Clinical Quality Specialist
Denver, CO · On-site
$72K - $82K/yr
What you'll do Utilization Management & Review * Conduct prospective, concurrent, and retrospective utilization reviews to assess medical necessity, treatment appropriateness, and level of care
Utilization Review Director
Englewood, CO · On-site
$52 - $71/hr
Interface with managed care organizations, external reviews, and other payers. * Participates in ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
Utilization Review Director
Englewood, CO · On-site
$52 - $71/hr
Interface with managed care organizations, external reviews, and other payers. * Participates in ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
Utilization Review Director
Englewood, CO · On-site
$52 - $71/hr
Interface with managed care organizations, external reviews, and other payers. * Participates in ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
New
Utilization Review Director
Englewood, CO · On-site
$52 - $71/hr
Interface with managed care organizations, external reviews, and other payers. * Participates in ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:
New
Appeals Pharmacist (Remote)
Colorado Springs, CO · On-site +1
$50.25 - $61.25/hr
Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:
Appeals Pharmacist (Remote)
Colorado Springs, CO · On-site +1
$50.25 - $61.25/hr
Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:
Appeals Pharmacist (Remote)
Aurora, CO · On-site +1
$57.25 - $69.75/hr
Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:
Appeals Pharmacist (Remote)
Aurora, CO · On-site +1
$57.25 - $69.75/hr
Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:
Remote Prior Authorization Pharmacist
Colorado Springs, CO · Remote
$51 - $61.25/hr
Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply. * Skills: Excellent clinical review ...
Remote Prior Authorization Pharmacist
Colorado Springs, CO · Remote
$51 - $61.25/hr
Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply. * Skills: Excellent clinical review ...
As a FMD, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
As a FMD, Interventional Pain Management, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Remote Prior Authorization Pharmacist
Aurora, CO · Remote
$58.25 - $70/hr
Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply. * Skills: Excellent clinical review ...
Remote Prior Authorization Pharmacist
Aurora, CO · Remote
$58.25 - $70/hr
Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply. * Skills: Excellent clinical review ...
Case Manager
Aurora, CO · On-site
$20.25 - $26.25/hr
Ability to apply elements of Utilization Management programs. Physical REQUIREMENTSMust be able to sit up to approximately 50 percent of the workday; stand and walk for the equivalent of several ...
Case Manager
Aurora, CO · On-site
$20.25 - $26.25/hr
Ability to apply elements of Utilization Management programs. Physical REQUIREMENTSMust be able to sit up to approximately 50 percent of the workday; stand and walk for the equivalent of several ...
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Manager, Care Management Transition of Care Team - Denver Health Medical Plan (Must Live in Color...
Denver, CO · On-site
$101K - $162K/yr
Workflows are outcomes oriented, and work will prioritize identification of high-risk members, proactive coordination of care with inpatient teams and health plan utilization management to meet ...
Manager, Care Management Transition of Care Team - Denver Health Medical Plan (Must Live in Color...
Denver, CO · On-site
$101K - $162K/yr
Workflows are outcomes oriented, and work will prioritize identification of high-risk members, proactive coordination of care with inpatient teams and health plan utilization management to meet ...
Epic Tapestry Consultant
Denver, CO · On-site +1
Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Strong desktop skills including Word, Excel, PowerPoint * Work Experience/Direct Knowledge of ...
Epic Tapestry Consultant
Denver, CO · On-site +1
Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Strong desktop skills including Word, Excel, PowerPoint * Work Experience/Direct Knowledge of ...
Behavioral Health Utilization Management Clinical Coordinator - Remote in Colorado preferred
Grand Junction, CO · On-site +1
Utilization Management experience *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to ...
Behavioral Health Utilization Management Clinical Coordinator - Remote in Colorado preferred
Grand Junction, CO · On-site +1
Utilization Management experience *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to ...
Epic Tapestry Specialist
Colorado Springs, CO · On-site +1
Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Ability to work independently and collaborate as part of a team * Effective written and verbal ...
Epic Tapestry Specialist
Colorado Springs, CO · On-site +1
Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Ability to work independently and collaborate as part of a team * Effective written and verbal ...
Epic Tapestry Consultant
Colorado Springs, CO · On-site +1
Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Strong desktop skills including Word, Excel, PowerPoint * Work Experience/Direct Knowledge of ...
Epic Tapestry Consultant
Colorado Springs, CO · On-site +1
Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Strong desktop skills including Word, Excel, PowerPoint * Work Experience/Direct Knowledge of ...
Epic Tapestry Specialist
Denver, CO · On-site +1
Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Ability to work independently and collaborate as part of a team * Effective written and verbal ...
Epic Tapestry Specialist
Denver, CO · On-site +1
Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Ability to work independently and collaborate as part of a team * Effective written and verbal ...
Utilization Management information
See Colorado salary details
$41K - $52.9K
15% of jobs
$52.9K - $64.7K
8% of jobs
$66.4K is the 25th percentile. Wages below this are outliers.
$64.7K - $76.6K
15% of jobs
The median wage is $84.1K / yr.
$76.6K - $88.4K
20% of jobs
$88.4K - $100.3K
11% of jobs
$106.2K is the 75th percentile. Wages above this are outliers.
$100.3K - $112.1K
13% of jobs
$112.1K - $124K
5% of jobs
$124K - $135.8K
3% of jobs
$135.8K - $147.7K
4% of jobs
$147.7K - $159.5K
3% of jobs
$159.5K - $171.4K
3% of jobs
$41K
$94.1K
$171.4K
How much do utilization management jobs pay per year?
What jobs pay 4000 a week without a degree?
What jobs pay $2000 a day?
What are the key skills and qualifications needed to thrive in the Utilization Management position, 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 is a Utilization Management job?
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 is the least stressful healthcare job?
What does utilization management do?
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.

Registered Nurse - Case Manager - Case Management - Full Time - Days
Montrose Regional HealthMontrose, CO
$5/hr
Other
Medical, Retirement
Posted 24 days ago
Montrose Regional Health rating
7.6
Based on 13 frontline employees who took The Breakroom Quiz
238th of 998 rated hospitals
Job description
About Montrose Regional Health:
- As the leading healthcare in the Uncompahgre Valley, MRH offers patients personalized and professional healthcare backed by the latest technology experience, and partnership, we continue to evolve and broaden our comprehensive services in 23-specialties and sub- specialties. We are the hospital, the healthcare resource, and the employer of choice in our communities. Montrose Regional Health is a not for-profit accredited by the Joint Commission meeting the highest standards of healthcare.
- Montrose Regional Health Case Managers help our patients understand their options concerning the specific situation they are dealing with at the time. We are liaisons between patients and their treatment or care options.
- The purpose of the Case Manager position is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care. The role integrates and coordinates utilization management, care facilitation and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans effectively in order to meet the needs, manage the length of stay, and promote efficient utilization of resources.
- Current and valid license to practice as a Registered Nurse in the state of Colorado.
- Five years clinical experience in clinical practice area minimum.
- Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
- Understanding of pre-acute and post-acute venues of care and post-acute community resources.
- Mentoring
- Student loan employer contributions up to $10,800 tax free!
- Relocation Assistance
- Continuing Education
- 401 K Retirement Plan with employer match
- Multiple health options to selection from
- Ability to earn an additional $5.00 with the professional development ladder
- Integrity & honesty in everything we do
- Service with care and compassion
- Excellence
- Leadership with innovation & Creativity
- We care for our team like family.
* This position is located in Montrose Colorado
About Montrose Regional Health
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
501 - 1,000 Employees
Headquarters location
Montrose, CO, US
Year founded
1950