ZipRecruiter

Log In

1

Utilization Review Case Manager Jobs in Colorado

next page

Showing results 1-20

All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Colorado

Utilization Review Case Manager information

See Colorado salary details

$17

$38

$63

How much do utilization review case manager jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for utilization review case manager in Colorado is $38.37, according to ZipRecruiter salary data. Most workers in this role earn between $31.11 and $40.43 per hour, depending on experience, location, and employer.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

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

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Colorado? For Utilization Review Case Manager jobs in Colorado, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Colorado look for? The top searched job categories for Utilization Review Case Manager jobs in Colorado are:
What cities in Colorado are hiring for Utilization Review Case Manager jobs? Cities in Colorado with the most Utilization Review Case Manager job openings:
Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Colorado as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 13% Part Time, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $79,801 per year, or $38.4 per hour.

Utilization Review Registered Nurse : On Site Position

Pioneers Medical Center

Meeker, CO • On-site

$33.50 - $49/hr

Other

Re-posted 8 days ago

Job description

Reports To : Director of Nursing; Acute and Emergency Department
FLSA Classification: Part-Time, Non-Exempt, Hourly $33.50 - $49-53
Essential Functions:
The Part-Time Utilization Review Nurse is a Registered Nurse (RN) responsible for conducting utilization reviews to determine the medical necessity and appropriateness of patient admissions, continued hospital stays, and the level of care provided. This role ensures compliance with regulatory requirements and payer guidelines, proactively identifies potential barriers to discharge, and works to prevent claim denials, thereby supporting efficient patient throughput and optimal resource utilization within the hospital.
- Perform concurrent and retrospective utilization reviews for all patient admissions and continued stays, applying established medical necessity criteria (e.g. InterQual, Milliman Care Guidelines), and payer specific guidelines.
- Communicate effectively with attending physicians, residents, and other healthcare providers regarding medical necessity, documentation requirements, and alternative levels of care.
- Identify and address potential barriers to discharge, collaborating with the Case Management team to facilitate timely patient progression.
- Document all review activities, including approvals, denials, and appeals processes, accurately and thoroughly in the electronic health record (EHR) system.
- Assist in the preparation and submission of appeals for denied services, providing clinical rationale and supporting documentation.
- Stay current with Medicare, Medicaid, and commercial payer regulations, policies, and medical necessity criteria.
- Collaborate with the Case Management team to ensure seamless coordination between utilization review and discharge planning activities.
- Participate in interdisciplinary team meetings to discuss patient status, care progression, and discharge readiness.
- Provide education to physicians and other staff on documentation requirements for medical necessity.
- Monitor readmissions and avoidable days in Meditech for quality improvement initiatives.
- Coordinate in advance discharge planning for orthopedic surgical patients, ensuring timely referrals, equipment orders, and post-discharge services.
- Actively participate in the Utilization Review (UR) Committee.
- Perform other duties as assigned to support utilization management, case management, and hospital operations.
- Other duties as assigned.
Education and Experience:
- Previous experience in managing staff and schedules required.
- Active, unencumbered Registered Nurse (RN) license in Colorado or Compact-state license that includes Colorado.
- Two (2) to three (3) years' of recent clinical experience in an acute care setting required.
- One (1) year of experience in Utilization Review or Case Management preferred.
- Strong knowledge of Medicare, Medicaid, and commercial payer regulations, as well as medical necessity criteria (e.g., InterQual, Milliman Care Guidelines).
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Apply