Utilization Review Registered Nurse : On Site Position

Job Category
:
Nursing RN LPN CNA PCT MA CMA

Requisition Number
: UTILI
001161

• Posted:
  February 26, 2026
• Part-Time

Showing 1 location

Meeker, CO 81641, USA

Reports To:

Director of Nursing;
Acute and Emergency Department

FLSA Classification:
Part-Time, Non-Exempt, Hourly $33.50 - $49-53

• Perform concurrent and retrospective utilization reviews for all patient admissions and continued stays, applying established medical necessity criteria (e.g. Inter Qual, Milliman Care Guidelines), and payer specific guidelines.
• Communicate effectively with attending physicians, residents, and other healthcare providers regarding medical necessity, documentation requirements, and alternative levels of care.
• Identify and address potential barriers to discharge, collaborating with the Case Management team to facilitate timely patient progression.
• Document all review activities, including approvals, denials, and appeals processes, accurately and thoroughly in the electronic health record (EHR) system.
• Assist in the preparation and submission of appeals for denied services, providing clinical rationale and supporting documentation.
• Stay current with Medicare, Medicaid, and commercial payer regulations, policies, and medical necessity criteria.
• Collaborate with the Case Management team to ensure seamless coordination between utilization review and discharge planning activities.
• Participate in interdisciplinary team meetings to discuss patient status, care progression, and discharge readiness.
• Provide education to physicians and other staff on documentation requirements for medical necessity.
• Monitor readmissions and avoidable days in Meditech for quality improvement initiatives.
• Coordinate in advance discharge planning for orthopedic surgical patients, ensuring timely referrals, equipment orders, and post-discharge services.
• Actively participate in the Utilization Review (UR) Committee.
• Perform other duties as assigned to support utilization management, case management, and hospital operations.
• Other duties as assigned.

• Previous experience in managing staff and schedules required.
• Active, unencumbered Registered Nurse (RN) license in Colorado or Compact-state license that includes Colorado.
• Two (2) to three (3) years’ of recent clinical experience in an acute care setting required.
• One (1) year of experience in Utilization Review or Case Management preferred.
• Strong knowledge of Medicare, Medicaid, and commercial payer regulations, as well as medical necessity criteria (e.g., Inter Qual, Milliman Care Guidelines).

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.