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Hiring organization
Denver Health
Registered Nurse, Utilization Coordinator
Denver, Colorado
Workplace not named in the posting.
RNHospitals and Health Care
Posted Jul 17, 2026 · Last seen active Jul 18, 2026
About this role
Under general supervision, the RN Utilization Review Coordinator will facilitate the appropriate status and level of care. This includes all commercial insurance, Medicare, Medicaid and self-pay. These will be reviewed on a cadence defined in the specific workflow. All Reviews will be done to ensure compliance with all state, federal and third-party payors. They will communicate daily and as needed to the RN Care Coordinator, Clinical Social Worker and healthcare teams.
Skills for this role
utilization reviewcare coordinationinsurance reviewcompliance reviewinterdisciplinary communication
Requirements
- (40%) Utilization Review for Insurance Companies Documents clinical information as required for insurance company certification according to required payor timeframe standards Works collaboratively with the Clerical Support Staff to ensure all insurance reviews are received by the insurance company and a disposition response is received Documents all insurance certification activities in the assigned locations according to the department documentation standards (40%) Compliance Ensures compliance with all applicable state and federal regulatory requirements as well as the insurance company rules such as Patient Choice, Important Message from Medicare #2, Condition Code 44, insurance certification processes, etc. Maintains compliance with established hospital policies, procedures, objectives, safety, environmental and infection control guidelines Protects Patient Rights as they pertain to the ethical and legal issues of confidentiality during the case management process (20%)
