Remote Utilization Management RN – Colorado

UCHealth; Aurora (CO); On-site; USD 54,000 - 83,000; Full time

Benefits offered by this job

Health insurance

Vision coverage

Dental coverage

401(k) match

Tuition reimbursement

Paid time off

Job summary

UCHealth in Colorado is seeking a Registered Nurse for a remote-capable role focused on utilization and case management. This fully remote opportunity requires residency in Colorado and adherence to payer guidelines and documentation standards.

The role emphasizes medical necessity reviews, discharge planning, and collaboration with clinical teams to balance quality care with cost efficiency. Expect strong critical thinking, minimal supervision, and a fast-paced environment.

Qualifications

• Bachelor's degree in Nursing required.
• State licensure as a Registered Nurse (RN).
• 3 years of relevant experience; preferred: 3 years utilization or case management experience.
• BLS/CPR through AHA or Red Cross; valid through 60 days after hire.

Responsibilities

• Reviews admissions and service requests for medical necessity and reimbursement policy.
• Provides case management or consultation for complex cases.
• Assists with Milliman guidelines, status determination, medical records, precertification, reimbursement and denials appeals.
• Collaborates with case managers to ensure accurate status and level of care; communicates with payers to secure patient accounts.
• Assesses and coordinates discharge planning with healthcare team.

Skills

RN

Case management

Medical necessity review

Education

Bachelor's degree in Nursing

Tools

BLS/CPR

Job description

UCHealth in Colorado is seeking a Registered Nurse for a remote-capable role focused on utilization and case management. This fully remote opportunity requires residency in Colorado and adherence to payer guidelines and documentation standards.

The role emphasizes medical necessity reviews, discharge planning, and collaboration with clinical teams to balance quality care with cost efficiency. Expect strong critical thinking, minimal supervision, and a fast-paced environment.