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Utilization review nurse jobs in Colorado

- 146 jobs
  • Utility Management Nurses (Insurance Coding & Revenue Management)

    Mercor

    Utilization review nurse job in Greeley, CO

    We're seeking experienced **Utility Management Nurses** to support a client's healthcare product development by leveraging expertise in **insurance coding and hospital revenue management workflows**. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. ### **Key Responsibilities** - **Insurance Coding & Revenue Cycle Alignment:** Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. - **Workflow Analysis:** Evaluate existing revenue management workflows and recommend improvements tailored to client's AI-driven documentation tools. - **Clinical Data Interpretation:** Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. - **Policy Matching:** Assess coding accuracy against insurance guidelines and payer documentation requirements. - **Product Development Collaboration:** Work closely with client's engineering and product teams to refine AI models that automate or assist with medical coding and documentation. - **Compliance & Quality Assurance:** Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. ### **Required Qualifications** - **Licensure:** Registered Nurse (RN) or equivalent clinical background. - **Experience:** Minimum 3-5 years in **medical coding**, **clinical documentation improvement (CDI)**, or **revenue cycle management**. - **Certifications:** CPC, CCS, or CRC certification preferred. - **Domain Expertise:** Familiarity with **hospital billing systems**, **payer policy interpretation**, and **coding audit procedures**. - **Analytical Skills:** Strong understanding of clinical documentation standards and payer logic. - **Tech Savvy:** Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. ### **Preferred Qualifications** - Experience working within **hospital revenue integrity teams** or **insurance utilization management**. - Exposure to **AI-powered healthcare documentation tools** or **automated coding systems**. - Ability to identify and flag edge cases or policy exceptions in automated workflows. - Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. ### **Engagement Model** - **Contract / Part-time (Remote/In person)** - Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus
    $55k-71k yearly est. 17d ago
  • Care unit travel nurse

    Cynet Health 4.5company rating

    Utilization review nurse job in Glenwood Springs, CO

    Cynet Health is seeking an experienced Coronary Care Unit Registered Nurse for an exciting Travel Nursing job in Glenwood Springs, CO. Shift: 3x12 hr days Start Date: ASAP Duration: 13 weeks Pay: $2722 / Week Ranked #5 Best Travel Nursing Companies 2022 by BluePipes. We offer the most competitive pay for every position we fill. We understand this is a partnership. You will have no surprises. Your salary will be discussed upfront and there will be no troubling negotiation tactics. Chat live with one of our recruiters 24x7 on our website @ or schedule a call
    $2.7k weekly 16h ago
  • Radiology Travel Nurse

    Medical Solutions 4.1company rating

    Utilization review nurse job in Englewood, CO

    Medical Solutions is seeking an experienced Medical Surgical Registered Nurse for an exciting Travel Nursing job in Englewood, CO. Shift: 3x12 hr days Start Date: 01/12/2026 Duration: 13 weeks A facility in Englewood, CO is seeking its next amazing RN (Registered Nurse) to work in Med Surg (Medical Surgical). Nurses and allied healthcare professionals are in high demand nationwide, and our team of industry-leading, traveler-favorite recruiters can get you where you want to go - personally and professionally. Wherever you may roam, travel healthcare helps you hone your skills and build an amazing resume. When you work with Medical Solutions, we've got your back 100% - starting with your co-captain and sidekick, your trusty recruiter. In addition to providing the industry's best recruiters, we offer tons of high-paying jobs, clinical support, and incredible benefits, including: ~ 1,000 unlimited referral bonus ~Paid, private, pet-friendly housing ~ Licensure/certification reimbursement ~ Free employee assistance program (EAP) ~ Day-one medical, dental, and vision insurance ~24/7 customer care ~ ACLS, BLS, NIHSS About Medical Solutions: Since 2001, Medical Solutions has made it our mission to provide "Service That Inspires" to our Travel Nurses, our Hospital Clients, and our internal employees. As a result, we're considered one of the most respected brands in the healthcare staffing industry, with thousands of Hospital Clients nationwide and an extensive network of skilled clinicians. Travel Nurses can expect the best service in the industry with Recruiters who are invested in their professional and personal success.
    $80k-136k yearly est. 16h ago
  • Travel Nurse - Nights - Medical Unit

    Fusion Medical Staffing 4.3company rating

    Utilization review nurse job in Englewood, CO

    Fusion Medical Staffing is seeking an experienced Stepdown Unit Registered Nurse for an exciting Travel Nursing job in Englewood, CO. Shift: Inquire Start Date: 01/05/2026 Duration: 13 weeks Pay: $1789 / Week Travel Stepdown RN Fusion Medical Staffing Facility in Englewood, Colorado Job Details Fusion Medical Staffing is seeking a skilled Stepdown RN for a 13-week travel assignment in Englewood, Colorado. One year of recent experience as a Stepdown RN Current Valid RN license in compliance with state regulations Progressive Care Certified Nurse (PCCN) Certification A Stepdown Registered Nurse provides care to patients who are transitioning from intensive care to medical-surgical or general inpatient units. These patients require frequent monitoring and specialized nursing interventions. They assess and manage complex patient needs, administer medications and treatments, and collaborate with multidisciplinary teams to ensure safe, patient-centered care. Monitors and interprets cardiac rhythms, vital signs, and other telemetry data to detect abnormalities and respond appropriately Administers prescribed medications and treatments in accordance with approved nursing techniques, with a focus on cardiac care Prepares equipment and aids physician during cardiac-related procedures and examinations Maintains awareness of comfort and safety needs of telemetry patients Observes patient, records significant conditions and reactions, and notifies supervisor or physician of patient's cardiac status and response to interventions Responds to life-saving situations based upon nursing standards, policies, procedures, and protocols specific to cardiac emergencies Documents nursing history and physical assessment for assigned telemetry patients Initiates patient education plans according to individualized needs, focusing on cardiac health, risk factors, and lifestyle modifications Collaborates with the interdisciplinary team to ensure comprehensive care for telemetry patients Adheres to hospital safety protocols, infection control guidelines, and regulatory standards The ability to read, write, and communicate in the English language Physical Abilities - Must be able to remain in a stationary position, move about, move equipment (50-100lbs), push, pull, and bend Technical/Motor Skills - Must have the ability to grasp, perform fine manipulation, push/pull, and move about when assisting with procedures and/or using department equipment Mental Requirements - Must be able to cope with frequent contact with the general public and customers while meeting deadlines under pressure. Must be able to work under close supervision occasionally, as well as working without assistance from other personnel. Sensory - Must possess visual acuity and ability to effectively communicate Highly competitive pay for travel professionals ~ Comprehensive medical, dental, and vision insurance with first day coverage ~ Life and Short-term disability offered ~Aggressive Refer-a-friend Bonus Program ~Reimbursement for licensure and CEUs At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch, and we're always looking for people like you to join our mission. Your passion for helping others deserves a partner just as committed to supporting you - that's why we offer day one insurance, $0 copay for mental health services, scholarships and awards, exclusive discounts, and more. From your personal recruiter to our clinical and traveler experience teams, we're here to guide and celebrate you along your journey. You take care of others; we take care of you. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Start your rewarding career as a Stepdown RN with Fusion Medical Staffing and join our mission to improve lives. Fusion is an EOE/E-Verify Employer About Fusion Medical Staffing: Fusion Medical Staffing provides career opportunities to healthcare professionals by helping medical facilities fill their staffing needs. Fusion staffs a variety of specialties within the nursing and allied healthcare fields. Specialty Fields: Home Health Long Term care Nursing Radiology Therapy
    $1.8k weekly 16h ago
  • Nurse Navigator - Urology

    Uchealth 4.3company rating

    Utilization review nurse job in Peyton, CO

    Department: Urology FTE: Full Time, 1.0, 80.00 hours per pay period (2 weeks) Shift: Days Pay: $38.91 - $60.31 / hour. Pay is dependent on applicant's relevant experience Serves as a patient advocate, liaison, and advisor/educator to assist patients with navigating the continuum of care. Responsibilities: Rounds on/reviews assigned patients regularly and evaluates patient progress with plan of care. Communicates plan of care to patient and family and solicits concerns, questions, and issues for resolution. Provides emotional support, counseling, clinical education and expert guidance to patients and families to promote their ability to understand and meaningfully participate in the healthcare process and personal decision-making. Serves as a liaison between patient and clinical staff, administration, physicians, managed care companies, and community/external resources to coordinate/maximize resources and identify/resolve barriers to the plan of care. Assists patients and families with resolving financial, psychosocial, functional, and administrative issues by advising of options and referring to appropriate resources. Intervenes as appropriate to advocate for patient and family. Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action. Requirements: Minimum Required Education: Graduate of an accredited or state board of nursing approved Registered/Professional Nursing program if less than 3 years experience. Preferred: Bachelor's degree in Nursing. Required Licensure/Certification: State licensure as a Registered Nurse (RN). Relevant life support certification as determined at position level. Minimum Experience: 2 years of nursing experience. BLS through the American Heart Association or the American Red Cross CPR for the Professional Rescuer with card in-hand before start date. BLS or CPR card must be good through sixty days of hire. We improve lives. In big ways through learning, healing, and discovery. In small, personal ways through human connection. But in all ways, we improve lives. UCHealth invests in its Workforce. UCHealth offers a Three Year Incentive Bonus to recognize employee's contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of three years' employment. UCHealth offers their employees a competitive and comprehensive total rewards package (benefit eligibility is based off of FTE status): Medical, dental and vision coverage including coverage for eligible dependents 403(b) with employer matching contributions Time away from work: paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence; start your employment at UCHealth with PTO in your bank Employer-paid basic life and accidental death and dismemberment coverage with buy-up coverage options Employer paid short term disability and long-term disability with buy-up coverage options Wellness benefits Full suite of voluntary benefits such as flexible spending accounts for health care and dependent care, health savings accounts (available with HD/HSA medical plan only), identity theft protection, pet insurance, and employee discount programs Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year Loan Repayment: UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program! UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi. UCHealth always welcomes talent. This position will be open for a minimum of three days and until a top applicant is identified. UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, color, national origin, language, culture, ethnicity, age, religion, sex, disability, sexual orientation, gender, veteran status, socioeconomic status, or any other characteristic prohibited by federal, state, or local law. UCHealth does not discriminate against any qualified applicant with a disability as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization. Who We Are (uchealth.org)
    $38.9-60.3 hourly 4d ago
  • Travel Nurse- Night Shift

    Stability Healthcare 4.2company rating

    Utilization review nurse job in Lone Tree, CO

    Stability Healthcare is seeking an experienced Medical Surgical Registered Nurse for an exciting Travel Nursing job in Lone Tree, CO. Shift: 3x12 hr days Start Date: ASAP Duration: 13 weeks Pay: $1580 / Week Stability HealthCare is a premier Per Diem and Travel Nurse Company. We provide the most qualified Nurses with great opportunities throughout the United States. We are recognized in the industry, not by our size, but the quality of our professionals, committed service, staff and consultative approach. As a dedicated healthcare professional, you want choices in your profession - choices that suit your lifestyle, your professional goals, and your personal needs. Stability believes that our Customers and Nurses come first! You deserve a healthcare staffing company that delivers on its promises - excellent compensation, personalized service and support every step of the way. If you are a registered nurse interested in Travel, Local Travel or Per Diem Nursing opportunities, Stability has the right assignment for you!
    $1.6k weekly 16h ago
  • Utilization Review RN

    Commonspirit Health

    Utilization review nurse job in Centennial, CO

    **Job Summary and Responsibilities** You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills - but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success. The Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Additionally, as a Utilization Review RN, you will collaborate with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market. **Schedule: Days (8:00am - 4:30pm) 7-days/week, Remote.** **Job Requirements** In addition to bringing humankindness to the workplace each day, qualified candidates will need the following: + Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. + Utilization Review experience strongly preferred. + Preferred graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or related healthcare field. + At least five (5) years of nursing experience + RN license in the state(s) covered is required. Physical Requirements - Medium Work - (Exert up to 50lbs force occasionally, and/or up to 20lbs frequently, and/or up to 10lbs constantly) **Where You'll Work** We believe in the healing power of humanity and serving the common good through our dedicated work and shared mission to celebrate humankindness. **Pay Range** $34.14 - $54.46 /hour We are an equal opportunity employer.
    $34.1-54.5 hourly 1d ago
  • Case Manager/Utilization Review Rn-Ft

    Memorial Regional Health 4.4company rating

    Utilization review nurse job in Craig, CO

    Provides individual case management and coordination of discharge of patients while coordinating transition care services for patients admitted to this service. Conducts utilization reviews to determine if patients are receiving care appropriate to illness, disease process, or condition. Reviews can take place as prospective, concurrent, and retrospective in nature. Essential Functions and Basic Duties: Position Specific Performance Expectations: Patient Care Specific: Tracks patient cases from admission to discharge. Ability to identify patients who are likely to suffer adverse health consequences upon discharge, needing coordination of support services ,and follow-up care based on diagnosis and level of acuity. Conducts timely evaluations for all patients identified by their physician, patient, nursing, family or friend requests, or discharge planner inquiry as needing discharge planning. Ability to develop individualized care plan for patients needing patient care planning support. Ability to use critical thinking skills supporting patients in accessing all necessary applicable resources for follow-up care: From admission (regardless of status) ensures that patients are “pre-qualified” for hospital admissions. Continued admission (regardless of status) ensures that patients are “re-qualified” for hospital admissions. Conducts appeals on behalf of the patient and family (at time of service and for hospital stay denials). Develops discharge plans for patients to the most appropriate plans of care - understands the resources available and advocates for the patient for those resources. Understands Lifeline, Transition Care, Swing Bed, Home Health, Hospice, Nursing Home Services, and can discern and explain which resource may be best for a specific patient based on diagnosis and level of acuity. Fully understands transitional care and how that service works with a Critical Access Hospital. Ability to advocate for patients and negotiate with physician and ancillary staff for patients. Ability to advocate for patients with insurance companies and CMS for additional services. Expert at InterQual and/or Millimen clinical decision-support criteria. Ability to identify patients at risk for abuse, depression, falls, or other conditions. Follows the proper procedures for reporting. Utilization Review Specific: Gathers pertinent clinical information and applies and interprets criteria to ensure medical necessity, covered benefits, participating providers, and appropriate services. Advocates that the patient is placed in the appropriate level of care and program. Interfaces with program staff to facilitate a smooth transition at the time of transfer or discharge. Monitors patient charts and records to evaluate care concurrent with the patient's treatment. Reviews treatment plans and status of approvals from insurers. Facilitates and coordinates discharge planning and works towards reduction of preventable hospital admissions, re-admissions, etc. Works closely with Revenue Cycle Department to ensure the insurance precertification process is complete and to update the denial log statistics on an ongoing basis (at least weekly), and initiate appeals through telephone or written communication within 7 to 10 days of denial. Collects and compiles data as required and rendering with applicable hospital policies as well as state and federal guidelines. Communicates with clinical care team with any outstanding or concerning findings during utilization review including, but not limited to: failure to meet medical necessity, inappropriate admission status, etc. Communicates with providers to obtain any medical record documentation necessary to perform utilization review. Documents any UR needs or notes into Electronic Medical Record (EMR). Administers or participates in audits of programs to ensure agency compliance on utilization review regulations. Performs other duties as assigned. Organization Wide Performance Expectations: Demonstrates 100% commitment to performing according to the CHOICE values of MRH and representing the organization in a positive and professional manner. Establishes and maintains effective verbal and written communication and good working relationships with all patients, staff and vendors. Adheres to MRH attire/dress code per policies and procedures. Utilizes initiative; strives to maintain steady level of productivity; self-motivated; manages activity and time. Completes annual education, training, in-service, and licensure/certification requirements; attends departmental and organizational staff meetings or reads meeting minutes. Maintains patient confidentiality at all times. Reports to work on time as scheduled; completes work within designated timeframes. Actively participates in departmental and facility performance improvement and continuous quality improvement activities. Strives to uphold regulatory requirements to ensure continual compliance with departmental, hospital, state and federal regulations and policies. Follows policies and procedures for infection control, safety, and risk management to ensure a safe environment for patients, public, and staff. Qualifications Minimum Requirements: Must be at least 16 years of age (21 for driving positions). Must be able to legally work in the United States. Must be able to pass a background check. Must be able to pass a drug screen and breath alcohol test (if applicable). Must complete employee health meeting. Required Education/Licensure/Certification: Unencumbered Colorado or Compact State RN License Current BLS certification (or must be obtained within 90 days). Experience: Minimum two (2) years of clinical experience preferred. Position Classification: Non-Exempt Compensation Range: $33.53 TO $50.29 Benefits: Medical, Dental, Life, Retirement, Paid Time Off
    $33.5-50.3 hourly 52d ago
  • Utilization Management Nurse

    Centerwell

    Utilization review nurse job in Denver, CO

    **Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent service to others. **Use your skills to make an impact** **Required Qualifications** + Active unrestricted RN license with the ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work independently and within a team setting + Willing to work in multiple time zones + Strong written and verbal communication skills + Attention to detail, strong computer skills including Microsoft office products + Ability to work in fast paced environment + Ability to form positive working relationships with all internal and external customers **Preferred Qualifications** + Education: BSN or bachelor's degree in a related field + Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health. + Bilingual **Alert** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Interview Format - HireVue** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. **Benefits** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-25-2025 **About us** About Conviva Senior Primary Care: Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of CenterWell Senior Primary Care, Conviva's innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health - addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************
    $71.1k-97.8k yearly Easy Apply 22d ago
  • RN Utilization Review Coordinator

    NRT |Foundry Treatment Center 4.7company rating

    Utilization review nurse job in Westminster, CO

    Job DescriptionDescription: RN Utilization Review Coordinator Reports to: Medical Director Job Category: Hourly | Non-Exempt | Full-Time Starting Salary: $34-$51/hour (DOE and licensure) Job Site: Hybrid (Broomfield, CO office/Home office) Job Summary: The Registered Nurse (RN) Utilization Review Coordinator plays a critical role in overseeing the clinical admission process and ensuring appropriate utilization of detox and residential treatment services. This position serves as the clinical decision-maker for all incoming admissions, verifying medical and psychiatric appropriateness, reviewing clinical documentation, and coordinating with referring providers, intake staff, and internal teams to ensure timely, safe, and clinically appropriate admissions. Additionally, the RN manages ongoing utilization review (UR) to maintain compliance with payer requirements and to support quality client care throughout the treatment continuum. Education and Experience: Current, unrestricted nursing license in Colorado (registered with DORA). RN, LPN Diploma, Associates, or Bachelors in Nursing; BSN preferred. Minimum two (2) years of experience in psychiatric, behavioral health, or substance use treatment. Strong knowledge of ASAM criteria and medical necessity standards for detox and residential levels of care. Prior experience with utilization review and insurance authorizations. Experience in a detox, dual-diagnosis, or residential treatment setting preferred. Familiarity with managed care requirements and UR software platforms preferred. BLS certification required. Required Skills/Abilities: Valid, non-restricted Colorado driver's license. Excellent clinical assessment, documentation, and communication skills. Ability to make sound clinical decisions under pressure and manage multiple priorities. Strong relationship building skills. Ability to listen well and offer solutions. Results driven with a proven track-record of meeting and exceeding defined goals. Ability to act with integrity, professionalism, and confidentiality. Strong collaboration skills with the ability to think creatively and share ideas. Ability to manage time effectively. Knowledge of industry and trauma-integrated care. Proficient with Google Workspace or related software. Proficiency with EHR systems and clinical documentation workflows. Must be available for on-call consultation for admission approvals as needed, including evenings or weekends. Duties/Responsibilities: Admissions Oversight: Review all incoming admission referrals for clinical and medical appropriateness. Approve or defer client admissions based on established medical and psychiatric criteria. Collaborate with Intake Coordinators, Milieu Managers, and clinical staff to ensure safe and efficient client transitions into care. Assess medical stability and risk factors prior to acceptance into detox or residential programs. Communicate directly with referral sources, payers, and internal departments regarding admission status and required documentation. Support intake team during high-volume periods to ensure smooth admissions flow. Utilization Review (UR): Conduct concurrent and retrospective utilization reviews to ensure services meet payer and regulatory standards. Prepare and submit clinical reviews and updates to insurance companies within required timeframes. Track authorizations, reauthorizations, and service limits, maintaining accurate and timely records. Collaborate with clinical and billing teams to resolve authorization or coverage issues. Participate in treatment planning discussions to ensure medical necessity and appropriate level of care are maintained. Clinical Support: Provide nursing assessments, medication reconciliation, and clinical input as needed during the admission process. Serve as a clinical resource to staff regarding psychiatric and detox-related care. Maintain accurate and timely documentation in the electronic health record (EHR). Maintains confidentiality and adheres to facility policies and procedures, State & Federal law, and accrediting agency regulations and standards. Physical Requirements: Prolonged periods of sitting at a desk and working on a computer. Standing, sitting, bending, reaching. Must be able to see, hear, talk, read, write, type. Exposure to clinical and medical environments. Must be able to lift 15 pounds at times. Driving in all weather conditions. Benefits & Perks: Health and Wellness Medical, dental and vision insurance* Supplemental accident and hospital indemnity coverage* Voluntary Term Life insurance* Employee Assistance Program Monthly wellness reimbursement* Financial Competitive salary Employee recognition and rewards programs Employee referral incentive program Employer-sponsored 401(k) plan Work/Life Perks Professional growth and development Continuing education reimbursement Unlimited paid time off (exempt employees) + sick days Paid time off policy (non-exempt employees) + sick days Paid holidays (exempt) or ability to earn 1.5x base hourly rate (non-exempt) *Full-time employees This description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice. Requirements:
    $34-51 hourly 26d ago
  • Telephonic Nurse Case Manager II

    Carebridge 3.8company rating

    Utilization review nurse job in Denver, CO

    Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. * This position will service members in different states; therefore, Multi-State Licensure will be required. This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Case Management experience. * Certification as a Case Manager. * Minimum 2 years' experience in acute care setting. * Managed Care experience. * Ability to talk and type at the same time. * Demonstrate critical thinking skills when interacting with members. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. * Ability to manage, review and respond to emails/instant messages in a timely fashion. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126.408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $76.9k-126.4k yearly Auto-Apply 60d+ ago
  • Nurse Case Manager II

    Elevance Health

    Utilization review nurse job in Denver, CO

    Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Schedule: Monday to Friday from 11:30 AM to 8:00 PM EST. * This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Nurse Case Manager II is responsible for care management within the scope of licensures for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Perform duties telephonically or on-site such as at hospitals for discharge planning. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiate rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current unrestricted RN license in applicable state(s) required. * Multi-state licensure is required if this individual provides services in multiple states. Preferred Experience, Skills, and Capabilities: * Case Management experience preferred. * Certification as a Case Manager preferred. * Managed Care experience preferred. * Ability to talk and type at the same time preferred. * Demonstrate critical thinking skills when interacting with members preferred. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred. * Ability to manage, review and respond to emails/instant messages in a timely fashion preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $76,944 to $120,912. Locations: Colorado; Illinois; Nevada In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $76.9k-120.9k yearly 10d ago
  • RN - Nurse Coordinator (PT)

    Rocky Mountain Health Care Services 4.2company rating

    Utilization review nurse job in Colorado Springs, CO

    Job Details Colorado Springs Pikes Peak Location - Colorado Springs, CO Colorado Springs Explorer Location - COLORADO SPRINGS, CO; Colorado Springs Quail Lake Location - Colorado Springs , CO Part Time 4 Year Degree $38.38 - $42.22 Hourly Negligible NurseJob Posting Date(s) 12/23/2025Description POSITION SUMMARY: The RN Home Care Coordinator position serves as a member of the Interdisciplinary Team (IDT) under the CMS regulations. As such, they are responsible for attending IDT meetings to present nursing interventions for care planning and to report on changes in condition for Rocky Mountain Health Care Services (RMHCS) participants. Participates in the communication of the participants condition to the RN Home Care Manager and the IDT. This position manages provider orders, provides phone triage to participants, and manages the schedule for home care nursing. An additional per diem is also offered on top of the pay scale listed. MISSION: Improving lives, Optimizing wellness, Promoting independence COMPETENCIES: Technical Expertise Problem Solving Teamwork Effective Communication Results Oriented Personal Credibility Quality Focus People Focus Flexibility RESPONSIBILITIES AND DUTIES: ESSENTIAL JOB FUNCTIONS: Serves as a member of the IDT Presents nursing interventions for participant care planning, fall reports, and incident reports Performs chart audits and ensures that nursing documentation is complete and accurate Acts as a support to home care nurses regarding procedures, documentation, and task organization Performs home visits to administer prescribed medications and treatments in accordance with nursing standards to supplement clinic services as needed Covers after hour and weekend call in rotation with other RMHCS NPs and RNs as needed. Observes, records, and reports participants condition and reaction to drugs and treatments to physicians Documents all interactions related to home care visits in the EMR Instructs participants and family members regarding medications and treatment instructions Keeps Home Care Manager and IDT informed on home care issues of participants as they arise Posts advance directives in participants homes and educate participants and families regarding plans of care Attends IDT meetings at care conferences, family meetings, and any other meetings as assigned Maintains personal supplies and materials needed for home visits. Ensures cleanliness. Prepares list of medical supplies needed and in stock Participates in continuing education classes and any required staff and training meetings. Maintains professional affiliations and any required certifications Other duties as requested/assigned Qualifications Graduate of an accredited Registered Nurse Program and licensed as a professional in the State of Colorado is required Minimum of one year of health care experience in hospital, long-term or home health care setting is preferred CPR and First Aid certification is preferred Must have excellent written and verbal communication skills and demonstrate the ability to interact clearly and effectively with both internal and external customers Proficient in software programs, such as Microsoft office and electronic medical records Knowledge of medical equipment and instruments Skill in applying and modifying the principles, methods and techniques of practical nursing to provide on-going care for participants Skilled in developing and maintaining department quality assurance. We strive to provide our employees with a comprehensive and affordable benefits package including Medical and Prescription Drug, One Medical, Dental, Vision Care, Wellness Program, Telemedicine Program, Flexible Spending Accounts, Health Savings Account, Company Paid Basic Life and Accidental Death & Dismemberment, Company Paid Long-Term Disability, Voluntary Life Insurance, Voluntary Short-Term Disability, Accidental Injury Insurance, Critical Illness, Hospital Indemnity, 403(b) Savings Plan, Legal Shield and IDShield, Employee Assistance Program (EAP), Paid Time-Off plan. Such benefits are based on applicable state law and factors such as pay classification (full-time, part-time, or PRN/casual), job grade and length of service.
    $38.4-42.2 hourly 60d+ ago
  • Nurse Case Manager |Behavioral Health Home

    Clinica 4.0company rating

    Utilization review nurse job in Longmont, CO

    "You get to do AMAZING work! Our Nurses are supportive to those who are pretty vulnerable, and you will be a guide to our clients as they gain a better understanding of how mental illness impacts their lives. You will play a great support and coaching role that will help them improve their lives. Your work with probation is key, as it is seen for this population, their mental health is better served in treatment than in jail." Lyda, Hiring Manager Job Profile: * Do you have your Bachelors of Science in Nursing and/or RN licensed to practice in the state of Colorado with mental health experience? * Want to work in an integrated team dedicated to deflect and redirect clients from incarceration and advance them to treatment? * Ready to work within behavioral health home clinic and get them stabilized in their communities? * Looking for a fun role where you get to spend time directly with the clients providing outreach and education on meds, health coaching, supportive counseling and being a trusted knowledge resource of mental health recovery? * Do you have a passion for advocacy for high-risk populations with substantial trauma history and have challenged negotiating any systems? Did you say YES to any of these questions? Now is the time to join us and use your RN experience to deepen your career in mental health. Oh, we want you to grow this us too! What's In It For You: * Medical (Kaiser and Cigna options), dental, vision, FSA, HSA, life, disability, and retirement (with company match) plans. * Mon-Fri Business Hours 8am-4:30pm - No Night Shift or Weekends * Paid time off, paid holidays, and a comprehensive wellness program * Engaged employer who believes you are an important factor in delivering our mission to the community with lots of opportunity to for dialogue with leaders * Training, personal, and professional growth opportunities * Supportive team that will participate in your development What we need for this job: * Bachelors in Nursing and/or RN License in CO * Collaborative and client centered with experience in an integrated center * Organization to manage client information, appointments and follow up items * Collaborative team member who is ready to jump in, support our clients and team * Passion for populations who arehigh risk and vulnerable to help them continue to engage with services that improve their overall wellness * Whole client care assessments and referrals, coordinate with the system, including prescribers and referrals to medical and dental; engage clients in their whole health We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. As a condition of employment, you will be required to receive the annual influenza vaccine. Medical exemptions or religious accommodations may be requested. This position will be open until 12/10/25 and will remaine open until a suitable candidate pool established.
    $64k-77k yearly est. 15d ago
  • Nurse Case Manager, Central Territory (Denver or Michigan)

    Argenx

    Utilization review nurse job in Denver, CO

    Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients. The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx's products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Roles and Responsibilities: Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx's policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills - with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx's policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Applicants must live in either Michigan or Denver. Current RN License in good standing Bachelor's degree preferred 5+ years of clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+ years of case management 2+ years of experience in pharmaceutical/biotech industry a must Reimbursement experience a plus Must live in geographically assigned territory Bilingual or multilingual a plus #LI-Remote For applicants in the United States: The annual base salary hiring range for this position is $136,000.00 - $204,000.00 USD. This range reflects our good faith estimate at the time of posting. Individual compensation is determined using objective, inclusive, and job-related criteria such as relevant experience, skills, demonstrated competencies and internal equity. This means actual pay may differ from the posted range when justified by these factors. Because market conditions evolve, pay ranges are reviewed regularly and may be adjusted to remain aligned with external benchmarks. This job is eligible to participate in our short-term and long-term incentive programs, subject to the terms and conditions of those plans and applicable policies. It also includes a comprehensive benefits package, including but not limited to retirement savings plans, health benefits and other benefits subject to the terms of the applicable plans and program guidelines. At argenx, all applicants are welcomed in an inclusive environment. They will receive equal consideration for employment without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other applicable legally protected characteristics. argenx is proud to be an equal opportunity employer. Before you submit your application, CV or any other personal details to us, please review our argenx Privacy Notice for Job Applicants to learn more about how argenx B.V. and its affiliates (“argenx”) will handle and protect your personal data. If you have any questions or you wish to exercise your privacy rights, please contact our Global Privacy Office by email at privacy@argenx.com . If you require reasonable accommodation in completing your application, interviewing, or otherwise participating in the candidate selection process please contact us at **************** . Only inquiries related to an accommodation request will receive a response.
    $61k-83k yearly est. Auto-Apply 28d ago
  • Outpatient Nurse

    Jefferson Center for Mental Health 4.0company rating

    Utilization review nurse job in Wheat Ridge, CO

    At Jefferson Center, it is our policy and our mission to be inclusive and mindful of the diversity of everyone who comes through our doors. We are passionate about building a community where mental health matters and equitable care is accessible to all races, ethnicities, abilities, socioeconomic statuses, ages, sexual orientations, gender expressions, religions, cultures, and languages. The Outpatient Nurse will provide psychiatric nursing services to patients at JCMH Outpatient offices. Collaborate with prescribers in all phases of medication management and follow-up, medication groups, medication problems and side effects and identify potential physical problems impacting the mental health of patients. Provide education to all patients and their families regarding psychiatric diagnoses. Education, Knowledge, Skills & Experience Required: * LPN, AARN, BSRN, MSRN with one or more years of experience and/or training in a psychiatric setting. * Applicant must have a good understanding of psychiatric diagnoses, along with the symptoms and medications used to treat those symptoms. * The candidate must have a good understanding of possible side effects of psychotropic medications. * Candidate must have developed awareness of various medical conditions, medication interactions and side effects that may affect the health or psychological functioning of a patient. * The candidate must have basic computer skills such as e-mail and prescription writing. * Bilingual (English/Spanish) preferred Essential Duties: * Coordinate prescription refills; respond to all refill requests within 3 business days. * Coordinate PAP refills: respond to all PAP refill requests within 3 business days * Assist in medication groups, as required. * Educate and assist patients with the filling of medication boxes. * Give long-acting injections. * Review and order labs, notify prescriber of any abnormal labs requiring immediate attention. * Assist prescribers in tracking and meeting timeframes for annual labs and AIMs * Ensure compliance with OSHA regulations. * Coordinate medication processing and applications with PAP office. * Work with the drug representatives to ensure medication cabinets are stocked. * Coordinate and run Clozaril groups, as determined by location * Provide patients with medication education. * Screen calls from patients involving medication problems and refills. Return calls promptly, within 72 hours during working days. Emergent calls will be returned the day that they are received. * Monitor patients for side effects of medications, including AIMS testing or any medical condition that may affect their mental illness. * Monitor and review patient's charts for medication/medical issues with appropriate follow-up. * Coordination of care with patient's prescriber, including documentation of medical medications & dosing, physical diagnoses, monitoring of potential medication interactions with psychiatric medications, and referrals as indicated. * Submit prior authorizations to patient's' insurance in a timely fashion. * Address medication changes with prescribers as needed. Other Duties: * Attend mandatory in-services, compliance with individualized training plan if required. * Participate in supervision by coming prepared with an agenda. Report high risk/problem cases and utilize a problem-solving approach as well as feedback. Attending supervision at times and intervals agreed upon with supervisor. * Work to engage child and adult patients and their families in the treatment process and goal setting. Identify risk factors including lethality. Work constructively with patients to reach agreed upon outcomes, and coordinate care with internal and external providers. * Applicants should exhibit enthusiasm, courtesy, adaptability, flexibility, and spirit of cooperation in the work environment. * Maintain effective interpersonal relations with patients, peers, subordinates, upper management, visitors and the general public. * Effectively respond to patients needs and problems, initiates and maintains positive interactions, timely response to phone calls, email and other requests. * Cooperate with other community agencies, as appropriate, and in agreement with supervisor. * Volunteer to work on Center committees and/or task forces. Note: Employees are held accountable for all duties of this job. This job description is intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the job. Salary Grade 12 (LPN): $57,200 to $61,360* ($27.50/hr - $29.50/hr) Salary Grade 15 (RN): $67,300 to $85,700 annually* Additional Salary Information*: * The salary range above is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.* Application Deadline: 12/15/2025. Review of applications will begin immediately.
    $67.3k-85.7k yearly 49d ago
  • Labor and Delivery Nurse (RN), FT

    Gunnison Valley Health 4.2company rating

    Utilization review nurse job in Gunnison, CO

    $10K Sign N Stay Bonus Eligible, reimbursed relocation stable, employer provided, affordable housing for up to 2 years. 150 top places to work in healthcare|2025 Becker's Hospital Review Labor Delivery and Recovery Nurse: Share your talents in providing compassionate and high quality care to expectant mothers during the labor and delivery process. This position includes a full range of patient support to include everything from childbirth and lactation education to monitoring vital signs, assisting with medical procedures and offering emotional support. We need your expertise to keep our community healthy and thriving! Where you'll live: Some define happiness by their job title and salary, while others pursue quality of life. Our community combines the best of both worlds by fostering a growing outdoor industry business hub in the heart of Colorado's Rocky Mountains. The Gunnison Valley, which includes the towns of Gunnison and Crested Butte, is a vibrant community of entrepreneurs and adventurers. We are deeply connected with our surrounding environment, neighbors and growing community. This is the kind of place where hard work is rewarded, whether that means a day on the mountain or at the office. Benefits: Here at Gunnison Valley Health, your good work will be rewarded. In addition to a competitive salary, a generous and affordable medical/dental/vision plan, and a dollar for dollar 401(a) match, up to 3%, there are other great perks including: Up to $250 in your first year toward your unique Lifestyle Spending Account, matched retirement starting on day 1, and a dependent care matching plan A culture that values continuing education, backed up by a robust tuition reimbursement plan, and an all-access subscription to LinkedIn Learning and Headspace. Relocation assistance, stable, employer provided affordable housing for up to 2 years, and a 10,000 Sign N Stay bonus Paid time off benefits with an accrual rate of 10.77% in your first year of employment Access to mental health, financial health and wellness as well as life coaching with our Employee Assistance Program Free nutrition consultations, and discounted fitness membership at Western Colorado University Fieldhouse Deep discounts on food and drink in the cafeteria No traffic, and a scenic commute to the office Requirements: To be seriously considered for this role, you'll need to have: Education: Bachelors or Associates Degree in Nursing (RN) from an accredited school. NRP, BLS, ACLS, PALS, and S.T.A.B.L.E Intermediate Fetal Monitoring Training at a minimum. Experience Must have at least 2 years of experience in Labor & Delivery Nursing. Licenses/Certification: Current Colorado State license or Compact license. Certification in Inpatient Obstetric Nursing (RNC - OB) preferred. Responsibilities: We are committed to improving the health of our community by delivering exceptional care and services. As part of the team in the Family Birth Center you will: Conduct thorough assessments of expectant mothers, monitor their health and identify any potential risks or complications. Provide continuous support by monitoring contractions, fetal heart rate and maternal vital signs. Assist the physician during the delivery process to ensure a safe and comfortable environment. Care for mothers and newborns during the immediate postpartum period. Educating and assisting with concerns and/or complications. Shift - Three 12-hour shifts/week Status - Full Time Compensation: $33.00 - $45.04/hour DOE (evening, night and weekend shift differential pay) In addition to the base salary, Nurses have the opportunity to increase their compensation through participation in our Clinical Ladder Program. This program recognizes and rewards engagement in organizational initiatives, professional development, leadership activities, and contributions to quality and patient safety efforts. Advancement on the Clinical Ladder is an opportunity to grow both professionally and financially. **Current GVH employees transferring departments are not eligible for the Sign N Stay Bonus There is no deadline to apply for this position; we are accepting applications on an ongoing basis until a finalist is selected. Your total compensation goes beyond the number on your paycheck. Gunnison Valley Health provides generous leave, health plans and retirement contributions that add to your bottom line. Benefits Eligibility Medical, dental, vision, health care FSA, dependent care FSA, and Lifestyle Spending Account: All active employees working 40 or more hours per pay period in a Full Time or Part Time position are eligible for benefits on the first of the month after hire. Full Time staff are automatically enrolled in 401A plan as of date of hire. Life and AD&D insurance: All active employees working 40 or more hours per pay period are eligible for benefits on the first of the month after hire date. Short-term and long-term disability: All active employees working 60 or more hours per pay period are eligible for benefits on the first of the month after hire date. Occasionally - Walking, sitting, feeling, crouching/squatting, stooping, kneeling, stairs, lifting/lowering (0-50 lbs), carrying (0-50 lbs), pushing/pulling (0-50 lbs) Frequently - Standing, change position, reaching, reach across midline, handling, pinching Continuously - See with corrective eyewear, hear clearly with assistance
    $33-45 hourly 60d+ ago
  • Radiology Travel Nurse

    Medical Solutions 4.1company rating

    Utilization review nurse job in Lone Tree, CO

    Medical Solutions is seeking an experienced Medical Surgical Registered Nurse for an exciting Travel Nursing job in Lone Tree, CO. Shift: 3x12 hr nights Start Date: ASAP Duration: 13 weeks A facility in Lone Tree, CO is seeking its next amazing RN (Registered Nurse) to work in Med Surg (Medical Surgical). Nurses and allied healthcare professionals are in high demand nationwide, and our team of industry-leading, traveler-favorite recruiters can get you where you want to go - personally and professionally. Wherever you may roam, travel healthcare helps you hone your skills and build an amazing resume. When you work with Medical Solutions, we've got your back 100% - starting with your co-captain and sidekick, your trusty recruiter. In addition to providing the industry's best recruiters, we offer tons of high-paying jobs, clinical support, and incredible benefits, including: ~ 1,000 unlimited referral bonus ~Paid, private, pet-friendly housing ~ Licensure/certification reimbursement ~ Free employee assistance program (EAP) ~ Day-one medical, dental, and vision insurance ~24/7 customer care ~ BLS About Medical Solutions: Since 2001, Medical Solutions has made it our mission to provide "Service That Inspires" to our Travel Nurses, our Hospital Clients, and our internal employees. As a result, we're considered one of the most respected brands in the healthcare staffing industry, with thousands of Hospital Clients nationwide and an extensive network of skilled clinicians. Travel Nurses can expect the best service in the industry with Recruiters who are invested in their professional and personal success.
    $80k-137k yearly est. 16h ago
  • Nursing House Supvr

    Uchealth 4.3company rating

    Utilization review nurse job in Estes Park, CO

    Department: EVMC Med Surg FTE: Part Time, 0.5, 40.00 hours per pay period (2 weeks) Shift: Nights Pay: $42.90 - $66.50 / hour. Pay is dependenton applicant's relevant experience Provides leadership for all nursing units and clinical support areas during assigned shift. Monitors and evaluates performance of agency and temporary staff, especially nursing staff. Responsibilities: Provides leadership, coaching, and mentoring to staff. Responds to staff requests for managerial assistance. Notifies MOC/AOC as necessary. Determines, coordinates, and monitors the flow of patients between units to maximize patient safety and experience and the use of the organization's resources . Evaluates the effectiveness of patient care and identifies any issues that affect desired patient outcomes. Coordinates patient care services with staff, physicians, and other departments. Responds to complaints/conflicts and manages through established channels. Makes administrative decisions in conjunction with the MOC/AOC. Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action. Requirements: ADN, BSN required for hires/transfers after 1/1/15. Preferred: Master's degree in Nursing or related field. State licensure as a Registered Nurse (RN). ACLS required for within 3 months of hire. 2 years of nursing experience. BLS through the American Heart Association or the American Red Cross CPR for the Professional Rescuer with card in-hand before start date. BLS or CPR card must be good through sixty days of hire. We improve lives. In big ways through learning, healing, and discovery. In small, personal ways through human connection. But in all ways, we improve lives. UCHealth invests in its Workforce. UCHealth offers a Three Year Incentive Bonus to recognize employee's contributions to our success in quality, patient experience, organizational growth, financial goals, and tenure with UCHealth. The bonus accumulates annually each October and is paid out in October following completion of three years' employment. UCHealth offers their employees a competitive and comprehensive total rewards package (benefit eligibility is based off of FTE status): Medical, dental and vision coverage including coverage for eligible dependents 403(b) with employer matching contributions Time away from work: paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence; start your employment at UCHealth with PTO in your bank Employer-paid basic life and accidental death and dismemberment coverage with buy-up coverage options Employer paid short term disability and long-term disability with buy-up coverage options Wellness benefits Full suite of voluntary benefits such as flexible spending accounts for health care and dependent care, health savings accounts (available with HD/HSA medical plan only), identity theft protection, pet insurance, and employee discount programs Education benefits for employees, including the opportunity to be eligible for 100% of tuition, books and fees paid for by UCHealth for specific educational degrees. Other programs may qualify for up to $5,250 pre-paid by UCHealth or in the form of tuition reimbursement each calendar year Loan Repayment: UCHealth is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program! UCHealth provides employees with free assistance navigating the PSLF program to submit their federal student loans for forgiveness through Savi. UCHealth always welcomes talent. This position will be open for a minimum of three days and until a top applicant is identified. UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, color, national origin, language, culture, ethnicity, age, religion, sex, disability, sexual orientation, gender, veteran status, socioeconomic status, or any other characteristic prohibited by federal, state, or local law. UCHealth does not discriminate against any qualified applicant with a disability as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization. Who We Are (uchealth.org)
    $42.9-66.5 hourly 2d ago
  • Staff RN - Intensive Care Unit ( Night Shift)

    Fusion Medical Staffing 4.3company rating

    Utilization review nurse job in La Junta, CO

    Fusion Medical Staffing is seeking an experienced Intensive Care Unit Registered Nurse for an exciting Travel Nursing job in La Junta, CO. Shift: Inquire Start Date: 01/12/2026 Duration: 13 weeks Pay: $2073 / Week Below covers everything you need to know about what this opportunity entails, as well as what is expected from applicants. Travel ICU RN Fusion Medical Staffing Facility in La Junta, Colorado Job Details Fusion Medical Staffing is seeking a ICU RN for a 13-week travel assignment in La Junta, Colorado. One year of recent experience as an ICU RN Valid RN license in compliance with state regulations Critical Care Registered Nurse (CCRN) certification Summary: The ICU Registered Nurse is responsible for providing comprehensive, critical care to patients in the intensive care unit. This role encompasses assessing and monitoring critically ill patients, operating life-support equipment, administering advanced treatments, and collaborating with multidisciplinary healthcare teams. The position requires strong critical care skills, advanced clinical judgment, excellent communication, and a commitment to maintaining the highest standards of patient safety and professional ethics in high-acuity settings. Administer complex medications and treatments in accordance with approved critical care nursing techniques Operate and manage advanced life support equipment Ensure patient safety and comfort in high-acuity ICU environments, addressing physical and emotional needs Perform and interpret advanced hemodynamic monitoring, including arterial lines, central venous pressure, and pulmonary artery catheters Accurately document all assessments, interventions, and patient responses in the medical record in a timely manner to ensure continuity of care and compliance with regulatory standards Provide education to patients and families regarding the ICU environment, treatments, and recovery expectations Communicate closely with interdisciplinary healthcare teams to optimize patient care Maintain proficiency in critical care procedures and technologies through ongoing education and training Adhere to strict infection control protocols to protect immunocompromised patients and reduce risks Engage in quality improvement initiatives to enhance ICU patient outcomes and operational efficiency Adhere to hospital safety protocols, infection control guidelines, and regulatory standards The ability to read, write, and communicate in the English language Physical Abilities - Must be able to remain in a stationary position, move about, move equipment (50-100lbs), push, pull, and bend Technical/Motor Skills - Must have the ability to grasp, perform fine manipulation, push/pull, and move about when assisting with procedures and/or using department equipment Mental Requirements - Must be able to cope with frequent contact with the general public and customers while meeting deadlines under pressure. Must be able to work under close supervision occasionally, as well as working without assistance from other personnel. Sensory - Must possess visual acuity and ability to effectively communicate Highly competitive pay for travel professionals ~ Comprehensive medical, dental, and vision insurance with first day coverage ~ Life and Short-term disability offered ~Aggressive Refer-a-friend Bonus Program ~Reimbursement for licensure and CEUs At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch, and we're always looking for people like you to join our mission. Your passion for helping others deserves a partner just as committed to supporting you - that's why we offer day one insurance, $0 copay for mental health services, scholarships and awards, exclusive discounts, and more. From your personal recruiter to our clinical and traveler experience teams, we're here to guide and celebrate you along your journey. You take care of others; we take care of you. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Start your rewarding career as a Travel ICU RN with Fusion Medical Staffing and join our mission to improve lives. Fusion is an EOE/E-Verify Employer About Fusion Medical Staffing: Fusion Medical Staffing provides career opportunities to healthcare professionals by helping medical facilities fill their staffing needs. xevrcyc Fusion staffs a variety of specialties within the nursing and allied healthcare fields. Specialty Fields: Home Health Long Term care Nursing Radiology Therapy
    $2.1k weekly 1d ago

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Top 4 Utilization Review Nurse companies in CO

  1. Centerwell

  2. Memorial Regional Hospital

  3. Commonspirit Health

  4. Mercor

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