Utilization Review Jobs in Colorado (NOW HIRING)

Position Summary

The Case Manager / Utilization Review (UR) is responsible for utilization review, discharge planning, patient advocacy, social services, and documentation review. This role evaluates the medical necessity of hospital admissions, ensures appropriate patient status and level of care, and collaborates with physicians to support accurate clinical documentation.

The position works closely with patients, families, providers, hospital departments, payers, and community resources to coordinate care and facilitate safe, timely discharges.

Essential Responsibilities

• Conduct concurrent reviews of hospital admissions to determine medical necessity and appropriate admission status.
• Perform ongoing chart and documentation reviews to support regulatory compliance and accurate reimbursement.
• Collaborate with physicians to ensure documentation accurately reflects patient severity and complexity of care.
• Interview patients and families to assess discharge planning needs.
• Develop and coordinate individualized discharge plans utilizing hospital and community resources.
• Provide psychosocial support, patient advocacy, and education to patients and families.
• Participate in interdisciplinary care conferences and coordinate care across departments.
• Complete Social Determinants of Health (SDOH) screenings as required.
• Present outlier cases to the Utilization Review Committee and attend committee meetings.
• Assist with denials management, audits, and payer-related issues.
• Serve as a resource for staff regarding medical necessity, level of care, and discharge planning.
• Maintain confidentiality and support a positive team environment.

Qualifications

Required

• Current Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in the State of Colorado.
• Minimum three (3) years of hospital-based nursing experience.
• Working knowledge of CMS regulations and medical necessity requirements.
• Experience with EMR systems, preferably Meditech.
• Strong communication, organizational, analytical, and problem-solving skills.
• Ability to prioritize workload, manage multiple tasks, and work independently.
• Strong interpersonal skills with the ability to effectively collaborate with physicians, staff, patients, and families.

Preferred

• Experience in utilization review, case management, discharge planning, or care coordination.
• Knowledge of Milliman Care Guidelines and quality improvement processes.

Why Join Delta Health?

Comprehensive Benefits Package

• Medical, RX, Dental & Vision - Low premiums with 100% coverage on services provided within the Delta Health system, and no deductibles or co-pays. Includes access to massage therapy, acupuncture, and chiropractic care.
• Life & Disability Insurance - Employer-paid coverage for your peace of mind.
• Time Off - Over 4 weeks of paid vacation annually (including sick and personal leave) for full-time staff.
• Retirement - 403(b) plan with up to a 2% employer match.

Work-Life Balance in a Stunning Location

Located on the Western Slope of the Rocky Mountains, Delta offers an unmatched combination of small-town charm, affordability, and natural beauty. Enjoy year-round outdoor activities such as hiking, skiing, mountain biking, fishing, and exploring the Grand Mesa and surrounding public lands. Whether you're raising a family or looking for work-life balance, Delta provides a safe, friendly community with a slower pace and a high quality of life. Delta is surrounded by the Grand Mesa, Uncompahgre Plateau, and nearby wineries, offering a unique blend of adventure and relaxation.

Delta Health is a county-wide healthcare system with more than 100 years of dedication to serving our community. Our 49-bed hospital and outpatient locations across Delta County are committed providing remarkable care in a healing environment. We operate with the core belief: Excellence. Every Patient. Every Time.

We are an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity or expression, age, national origin, disability, veteran status, or any other protected characteristic