Utilization Review Coordinator jobs in Colorado

Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)

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Utilization Review Coordinator
  • Pinnacol Assurance
  • Denver, CO FULL_TIME
  • Pinnacol Assurance does just one thing, and does it better than anyone: provide caring workers’ compensation protection to Colorado employers and employees. And while we may be a little biased, we believe that our work shapes communities and changes lives.

    We have big hearts and love big ideas. We’ve been around for more than  100 years, but don’t let that fool you. Pinnacol is committed to taking care of Colorado employers and workers in the most innovative ways. We celebrate continuous improvement, new ideas, compassion, teamwork, integrity and excellence.

    With our number one priority to keep everyone safe, along with the heart of Pinnacol’s “culture of caring” to do what is right and not what is easy, we’re currently having our team members work from home. But we’re still making time for fun with virtual events like virtual painting classes, virtual yoga and Zumba classes, and virtual happy hours!

    What you’ll do:

    Responsible for helping to establish a new utilization review (UR) department within Pinnacol. Key areas of focus include carrying out reviews of medical records and prior authorization requests to determine the clinical necessity and appropriateness of medical services that have been requested or previously furnished. To inform these reviews, follows standardized protocols informed by evidence-based guidelines and similar literature. Communicates with community medical providers to request information and provide education. Shares pertinent information with independent physician advisors who make final payment (coverage) determinations. Communicates with injured workers about coverage decisions. Collaborates with bill pay processors to ensure that approved and denied services are paid appropriately. Collaborates as needed with medical nurse case managers, claims adjustors, and other internal and external stakeholders.  Supports and participates in a transition towards increasing UR efficiency and automation by taking advantage of new software that streamlines workflows and helps manage information and communication.

    What you can expect:

    • Conducts timely preauthorization and retrospective utilization reviews and manages appeals.
    • Develops expertise in clinical appropriateness criteria for specific kinds of medical services.
    • Organizes and communicates information necessary to complete reviews.
    • Communicates with injured workers about coverage decisions.
    • Communicates necessary information with billing to ensure payment appropriateness.
    • Maintains current and accurate documentation in Salesforce, Excel, WCIS, and Medata systems.
    • Accurately documents all review determinations and contacts providers and members according to established time frames.
    • Identifies and refers cases that do not meet established clinical criteria to the utilization review management team.
    • Collaborates with Claims, Quality Management, Nurse Case Management, and Provider Relations as requested.
    • Good interpersonal skills, able convey disappointing information tactfully and empathically.
    • Ability to multi-task and work efficiently in a busy environment; flexibility to alternate between on- site and remote work.
    • Highly organized; excellent documentation skills; strong ability to keep track of tasks and meet deadlines; detail-oriented; attentive to ensuring data integrity and informational accuracy.
    • Proactive about identifying and solving problems; timely and resourceful in relation to soliciting
    • Has a curious mindset; an openness to learning about and developing expertise in new software packages and applications.
    • Has a reasonable level of comfort with organizational change and sustained attention to continuous

    Additional Duties:

    • Manage conflicting priorities involving multiple utilization review projects and cross functional team members
    • Support Pinnacol’s culture by striving for excellence in all aspects of the job with a focus on positive interpersonal relationships with co-workers
    • Ability to build credibility and establish trust within the medical community and all levels of Pinnacol
    • Perform other duties as assigned

    What you need to be successful:

    • High school or equivalent; 4 year college degree (preferred).
    • Minimum of 1 year of experience in a position involving analytic evaluations of written information.
    • Experience in a health care setting that involved gaining familiarity with health care operations and billing (preferred).

    We can’t do our work without people like you.
    Our employees are extraordinary and committed to making a difference. Here’s some of the ways we show our appreciation.

    • Our benefits go beyond the basics. You’ll get to choose from diverse benefit offerings for medical, dental and vision.
    • We care about each other. We enjoy a positive, collaborative work environment. We are hard workers and high performers.
    • We love who you are. Pinnacol is on a journey to embody diversity, equity and inclusion. We’re committed to creating a culture that deeply values differences, where everyone feels like they belong.
    • Take a day (or 20!) off. Enjoy 20 paid days off your first full year plus 9 paid holidays.
    • Take care of yourself. Sign up for unique wellness programs, including on-site, company-paid fitness facilities and classes
    • Get your learning on. We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of on-site, online, and off-site professional development opportunities.
    • Give back and get paid. Through our employee volunteer program, Pinnacol in Action, employees receive paid time off to volunteer with Colorado nonprofits.
    • Share in our success. You’ll have the opportunity to earn a quarterly incentive, up to 20 percent of your annual base salary, when your team exceeds their goals and objectives.

    When we find the right person, we try to put our best foot forward with an offer that excites you. We consider what you’d like to be paid, the skills and experience you bring, what similar jobs pay in the Denver area and make sure there’s equal pay for equal work among those you’ll be working with. The compensation amount for this role is targeted at $49,700-$53,700/yr. Final offer amounts are determined by multiple factors including your experience and expertise and may vary from the amounts listed above.

    Want to love your work? Apply today!

    Pinnacol is committed to working with and providing reasonable accommodations to applicants with disabilities. To request assistance with the application process, please email recruiting_team@pinnacol.com.

    This posting will close 15 days from after being published. It is scheduled to close on March 11th, 2024.

  • 28 Days Ago

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Utilization Review/Management Coordinator - Behavioral Health Setting
  • UHS
  • HIGHLANDS RANCH, CO FULL_TIME
  • Responsibilities Utilization Review/Management CoordinatorFull-Time - Monday - Friday, rotating weekend day required Salary range: $30.00 - $46.84 (DOE and licensure status) Highlands Behavioral Healt...
  • 24 Days Ago

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Coordinator, HCM Utilization Review Case Management
  • Denver Health
  • Denver, CO FULL_TIME
  • We are recruiting for a Coordinator, HCM Utilization Review Case Management to join our team!We are here for life's journey.Where is your life journey taking you?Being the heartbeat of Denver means ou...
  • 15 Days Ago

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Utilization Review/Management Coordinator (Outpatient) - Behavioral Health Setting (In-Person)
  • Highlands Behavioral Health System
  • Highlands, CO FULL_TIME
  • Responsibilities: Highlands Behavioral Health System is an 86 bed, acute care psychiatric hospital located in Littleton, CO. Highlands features individual units for adolescents, adults, and seniors, a...
  • 1 Month Ago

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Utilization Review Specialist
  • Springstone, Inc.
  • Englewood, CO FULL_TIME
  • Overview Fully On-Site Role Utilization Review Specialist Salary/Hourly: $23- $31.00/hour Denver Springs Summary of Benefits Link Members of our team Enjoy: Working with a highly engaged staff Healthy...
  • 1 Month Ago

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Utilization Review Specialist
  • Denver Springs
  • Englewood, CO FULL_TIME
  • Overview Fully On-Site Role Utilization Review Specialist Salary/Hourly: $23- $31.00/hour Denver Springs Summary of Benefits Link Members of our team Enjoy: Working with a highly engaged staff Healthy...
  • 1 Month Ago

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Facilities Utilities Supervisor
  • Ajulia Executive Search
  • Princeton, NJ
  • Facilities Utilities Supervisor Immediate Hire OSHA standards Maintaining and repairing mechanical, electrical, plumbing...
  • 3/29/2024 12:00:00 AM

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Utilities Supervisor
  • System One Holdings, LLC
  • Hightstown, NJ
  • SUMMARY Perform periodic maintenance of utilities equipment. Responsible for HVAC, water system and Boiler area day to d...
  • 3/28/2024 12:00:00 AM

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Utilization Review Coordinator
  • TheraMatrix
  • Pontiac, MI
  • Job Description Job Description Duties and Responsibilities: Initial authorizations of outpatient physical therapy servi...
  • 3/28/2024 12:00:00 AM

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Utilization Reviewer Coordinator
  • NeuroBehavioral Hospitals
  • West Palm Beach, FL
  • You Matter: Make a difference every day in the lives of the underserved Join a mission driven organization with a people...
  • 3/26/2024 12:00:00 AM

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Refrigeration/Utilities Supervisor
  • Boar's Head Brand/Frank Brunckhorst Co., LLC
  • New Castle, IN
  • Hiring Company: Boar's Head Provisions Co., Inc. Overview:Reporting directly to the Facility Manager, this position is r...
  • 3/26/2024 12:00:00 AM

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TEMP FT UTILIZATION REVIEW COORDINATOR
  • UHS
  • Jacksonville, FL
  • Responsibilities Universal Health Services, Inc. , one of the nation's largest and most respected providers of hospital ...
  • 3/25/2024 12:00:00 AM

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Utilization Review Coordinator / Case Management / PRN
  • Christus Health
  • Santa fe, NM
  • Description POSITION SUMMARY: Registered Nurse uses approved screening criteria (MCG®/CMS Inpatient List) to determine t...
  • 3/25/2024 12:00:00 AM

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Utility Coordinator
  • KEITH
  • Miami, FL
  • Utility Coordinator - Miami, FL KEITH is seeking a Utility Coordinator to join our Miami, FL office to strengthen our gr...
  • 3/25/2024 12:00:00 AM

Colorado (/ˌkɒləˈrædoʊ, -ˈrɑːdoʊ/ (listen), other variants) is a state of the Western United States encompassing most of the southern Rocky Mountains as well as the northeastern portion of the Colorado Plateau and the western edge of the Great Plains. It is the 8th most extensive and 21st most populous U.S. state. The estimated population of Colorado was 5,695,564 on July 1, 2018, an increase of 13.25% since the 2010 United States Census. The state was named for the Colorado River, which early Spanish explorers named the Río Colorado for the ruddy silt the river carried from the mountains. The...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$81,501 to $100,951

Utilization Review Coordinator in Long Beach, CA
The Utilization Review Coordinator contributes to moderately complex aspects of a project.
January 05, 2020
Utilization Review Coordinator in Gary, IN
Candidates for this role must have a good understanding of medical terminologies, and stay tuned with latest developments in the field; they should possess knowledge of reviews such as MAC, KEPRO, and RAC; strong observing skills and the ability to monitor safety plans are also needed.
December 29, 2019
Utilization Review Coordinator in Chicago, IL
Including requirements, responsibilities, statistics, industries, similar jobs and job openings for Utilization Review Coordinator.
December 30, 2019