Top 121 Utilization review Jobs in Denver, Co

Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement))
Denver Health —Denver, CO
- $143,800 - $237,300 a year
- Full-time
- Hybrid work
- Nursing
- Pass drug screening
- Office
- Paid parental leave
- Paid holidays
Home Health Registered Nurse
Premier Home Health Care Northglenn, CO —Denver, CO
- $52 - $110 an hour
- Weekends as needed
- Background check
- CPR Certification
- RN License
- Health insurance
- Dental insurance
Quick Apply
Case Manager (Registered Nurse/RN)
Life Care Center of Stonegate —Parker, CO
- $40 - $48 an hour
- Full-time
- Nursing
- RN License
- Customer service
Quick Apply
Registered Nurse - Denver Area
Confidential —Denver, CO
- $70 - $90 an hour
- Weekends as needed
- CPR Certification
- Nursing
- Management
- Flexible schedule
Quick Apply
Registered Nurse - Utilization Review
Software Technology Inc —Aurora, CO
- Overtime
- Nursing
- RN License
- BLS Certification
- Work from home
Quick Apply
Utilization Review Director
Denver Springs —Englewood, CO
- $110,000 - $148,000 a year
- Full-time
- Management
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Registered Nurse, Utilization Coordinator - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement)
Denver Health —Denver, CO
- $71,400 - $107,100 a year
- Full-time
- Hybrid work
- Nursing
- RN License
- Customer service
- Paid parental leave
- Paid holidays
Registered Nurse - Utilization Review (Nursing)
Software Technology Inc —Aurora, CO
- Overtime
- Nursing
- Management
- RN License
- Work from home
Quick Apply
Continued Stay Coordinator
InnovAge —Denver, CO
- $22.84 - $27.40 an hour
- Email
- Remote
- Background check
- HIPAA
- Mid-level
- AD&D insurance
- Paid holidays
FT SW Care Manager
AdventHealth Littleton —Littleton, CO
- $26.89 - $50.01 an hour
- Full-time
- Microsoft Outlook
- Hospital
- Computer literacy
- Paid parental leave
- Disability insurance
PT SW Care Manager - some weekend requirement
AdventHealth Littleton —Littleton, CO
- $26.89 - $50.01 an hour
- Part-time
- Microsoft Outlook
- Hospital
- Customer service
- Paid parental leave
- Disability insurance
Senior Consultant - Clinical Documentation Specialist
Deloitte —Denver, CO
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Population Health RN Case Manager
University of Colorado —Aurora, CO
- $83,794 - $100,552 a year
- Overtime
- Hybrid work
- Background check
- Spanish
- CPR Certification
- Disability insurance
- Health insurance
SW Care Manager PRN
AdventHealth Littleton —Littleton, CO
- $26.89 - $50.01 an hour
- PRN
- Microsoft Outlook
- Computer literacy
- Inpatient
Physician Opportunities
Summit Medical Consultants LLC —Denver, CO
- $275,000 - $300,000 a year
- 8 hour shift
- Medicine
- Skilled nursing facility
- Doctoral degree
- Health savings account
- Relocation assistance
Quick Apply
Director, Pharmacy - Denver Health Medical Plan (* Hybrid Work Schedule *)
Denver Health —Denver, CO
- $150,900 - $249,100 a year
- Full-time
- Hybrid work
- Customer service
- Pass drug screening
- Office
- Paid parental leave
- Paid holidays
Physical Therapist
Ridgeview Post Acute —Commerce City, CO
- $42 - $51 an hour
- Full-time
- Background check
- Skilled nursing facility
- Customer service
- Continuing education credits
- Health savings account
Quick Apply
Part - Time Physician Opportunities
Summit Medical Consultants LLC —Denver, CO
- $35,000 - $160,000 a year
- Part-time
- Medicine
- Skilled nursing facility
- BC/BE
Quick Apply
Nurse Practitioner & Physician Assistant Opportunity
Summit Medical Consultants LLC —Denver, CO
- $100,000 - $120,000 a year
- 8 hour shift
- Skilled nursing facility
- BLS Certification
- Mid-level
- Paid holidays
- Disability insurance
Quick Apply
Occupational Therapist
Ridgeview Post Acute —Commerce City, CO
- $41 - $50 an hour
- Full-time
- Background check
- Skilled nursing facility
- Customer service
- Wellness program
- Health savings account
Quick Apply

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Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement))

Denver Health -
Denver, CO

Apply Now

Job Details

Full-time
$143,800 - $237,300 a year

Benefits

Paid parental leave
Paid holidays
Disability insurance
Health insurance
On-site gym
Dental insurance
Tuition reimbursement
Paid time off
Parental leave
Vision insurance
Employee discount
Loan forgiveness
Life insurance
Childcare
Retirement plan

Qualifications

Program design
Vendor management
Team leadership
Operational management
Master's degree
Health insurance knowledge
Medicare regulations
Educational program evaluation
Senior leadership

Full Job Description

We are recruiting for a mission-driven Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement)) to join our team!

We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.

Our Values

Respect | Belonging | Accountability | Transparency

Department

Managed Care Administration

* Must Live in Colorado

* This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week.

Job Summary

The Senior Director of Health Plan Utilization Management is a senior leader for the Denver Health Medical Plan (DHMP) with responsibility for providing strategic and operational leadership for all utilization management functions across the organization. This area has unique regulatory and contractual compliance requirements for each line of business. This role is responsible for ensuring clinically appropriate, cost-effective, and regulatory-compliant medical necessity determinations while supporting high-quality member outcomes and provider collaboration. The Senior Director partners closely with Operations, Network Management, Quality, Compliance, and Finance to align utilization management strategy with organizational goals. In this capacity, the Senior Director oversees multiple teams performing this work. The Director reports to the DHMP Chief Medical Officer and collaborates closely with them to develop, update and implement the DHMP Utilization Management vision and strategy.

Essential Functions :

Assures that all staff are appropriately trained on all relevant software programs and applications necessary to perform their job functions. (10%)
Participates in presentation of reports to the Operations Team, DHMP Board of Directors, and other bodies, as required. (10%)
Attends and participates in Quality Management Committee, DHMP Operations Team meetings, Utilization Management Committee, enterprise Care Coordination meetings and other related meetings and activities as required. (10%)
Serves as an issue-related or escalation liaison between Utilization Management and other departments and/or agencies both within DH, contractors and/or plan members. (10%)
Oversees the maintenance, development, implementation, and continuous improvement of UM policies and procedures and management of information systems to accomplish UM goals for all contracted populations. (10%)
Develops, analyzes, and presents reports on productivity, quality and outcomes. (10%)
Ensures DHMP can provide documentation of compliance with contractual and regulatory requirements prior to audit by the State, CMS, DOI, etc. (10%)
Develops, implements, and evaluates formal educational activities and follows up on issues identified through educational activities. Brings new knowledge to staff meetings. (10%)
Works closely with DHMP Compliance Officer to ensure all DHMP lines of business operational performance meets or exceeds regulatory requirements including, but not limited to, policies and procedures reporting. Acts as a voting member of the DHMP Compliance Committee. (10%)

Education :

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

Work Experience :

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

Licenses :
Knowledge, Skills and Abilities :

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

* Must Live in Colorado

* This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week.

Shift

Days (United States of America)

Work Type

Regular

Salary

$143,800.00 - $237,300.00 / yr

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development — while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado’s primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.

Apply Now

Refine Your Search

utilization review jobs in denver, co

Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement))

Home Health Registered Nurse

Case Manager (Registered Nurse/RN)

Registered Nurse - Denver Area

Registered Nurse - Utilization Review

Utilization Review Director

Registered Nurse, Utilization Coordinator - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement)

Registered Nurse - Utilization Review (Nursing)

Continued Stay Coordinator

FT SW Care Manager

PT SW Care Manager - some weekend requirement

Senior Consultant - Clinical Documentation Specialist

Population Health RN Case Manager

SW Care Manager PRN

Physician Opportunities

Director, Pharmacy - Denver Health Medical Plan (* Hybrid Work Schedule *)

Physical Therapist

Part - Time Physician Opportunities

Nurse Practitioner & Physician Assistant Opportunity

Occupational Therapist

I want to receive the latest job alert for utilization review in denver, co

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