Registered Nurse Utilization Review Flex

Children's Hospital Colorado Aurora, CO, US

$50.68 / hour

Job Overview

The Utilization Review RN participates as a member of a multidisciplinary team to support medical necessity reviews, ensure compliance, and actively participate in denial mitigation. It is a collaborative approach that uses pre-established guidelines and criteria to perform review activities to ensure the proper utilization of hospital services and payment of those services by Medicare, Medicaid, and other third-party payors.

Department Name: Utilization Management

Job Status: flex, not eligible for benefits

Shift: variable - must have availability to work at least 24 hours per 2-week pay period. Shifts may include dayshift, evening shift, and weekend shifts, depending on unit staffing needs.

Duties & Responsibilities

Assesses all new inpatient admissions for identification of status and medical necessity for admission; communicates clinical review process with appropriate Payors.
Assesses the continuity of care in conjunction with the Case Managers regarding the continued medical necessity of hospitalization and the status of the discharge plan; communicates this to the appropriate payors.
Coordinates with other members of the healthcare team to help identify and control inappropriate resource utilization.
Conducts concurrent admission and continued stay reviews based on appropriate utilization review criteria.
Utilizes information provided by Patient Access regarding authorized length of stay and follows up with third-party payors on an ongoing basis, documents communications regarding continued authorizations.
Follows up on denials communicated to the department and works with the revenue cycle staff to assist with appeals.
Maintains and demonstrates appropriate clinical knowledge to assist physicians in providing documentation of severity of illness and intensity of service to assure that criteria for acute hospitalization are met.
Employees are expected to comply with all regulatory requirements, including CMS and Joint Commission Standards.

Minimum Qualifications

EDUCATION – Bachelor of Science in Nursing (BSN)
EXPERIENCE – Three years of nursing experience in a pediatric setting or three years of Case Management experience. Needs to include recent UR experience in a hospital or with a Third-Party Payor
CERTIFICATION(S) – BLS/CPR from the American Heart Association with at least six (6) months left before expiration is required upon hire
LICENSURE – Current Colorado Registered Nurse (RN) license or RN license multistate compact

Salary Information

Hourly Rate of Pay: $50.68

Benefits Information

As a Children’s Hospital Colorado team member, you will receive a competitive pay and benefits package designed to take care of your needs that includes base pay, incentives, paid sick leave and a robust wellness program.

As part of our Total Rewards package, Children's Colorado offers an annual employee bonus program that rewards eligible team members based on organizational performance. If organizational goals are met for the year, the bonus is paid out the following April.

Children’s Colorado delivers annual base pay increases to eligible team members based on their performance over the previous year.

EEO Statement

It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. Be aware that none of the questions are intended to imply illegal preferences or discrimination based on non-job-related information. The position is expected to stay open until the posted close date. Please submit your application as soon as possible as the posting is subject to close at any time once a sufficient pool of qualified applicants is obtained.

Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of attendance at or graduation from an educational institution. You will not be penalized for redacting or removing this information.

Share this job

Related Jobs

Other

2 years ago

Registered Nurse (RN PRN)

Wellpath Castle Rock, CO

How you make a difference As a Registered Nurse (RN), your primary responsibility is to provide patient care using the nursing process of assessment, planning, implementation, and evaluation. You will work under the supervision of Charge Nurse(s) to provide patient education and activities in accordance with your competencies and education. This role requires excellent communication and critical thinking skills to ensure optimal patient outcomes. Additional Details Deadline to apply to this position is April 22nd, 2026. Application deadline may be extended contingent upon applicants’ volume. Qualifications & Requirements Education Graduate from an accredited school of nursing. Experience Prefer a minimum of one (1) year clinic experience Licenses/Certifications Have and maintain current licensure as a Registered Nurse within the state of employment. Must be able to obtain and maintain CPR certification. Key Responsibilities Assist in assessing and planning individual treatment programs, consulting with Charge Nurse(s) and other staff as necessary. Implement medical plans by administering medications, obtaining diagnostic tests, and assisting with medical or minor surgical procedures as needed. Count controlled substances and implement clinical and technical aspects of care in accordance with established policies, procedures, and protocols. Document nursing encounters using the SOAP form of charting as required by policy and attend mandatory staff meetings and training. Communicate information to nursing staff, physician, health care unit supervisory personnel or other staff as necessary. You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.

Full-time

2 years ago

Registered Nurse (RN Nights)

Wellpath Castle Rock, CO

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference As a Registered Nurse (RN), your primary responsibility is to provide patient care using the nursing process of assessment, planning, implementation, and evaluation. You will work under the supervision of Charge Nurse(s) to provide patient education and activities in accordance with your competencies and education. This role requires excellent communication and critical thinking skills to ensure optimal patient outcomes. Key Responsibilities Assist in assessing and planning individual treatment programs, consulting with Charge Nurse(s) and other staff as necessary. Implement medical plans by administering medications, obtaining diagnostic tests, and assisting with medical or minor surgical procedures as needed. Count controlled substances and implement clinical and technical aspects of care in accordance with established policies, procedures, and protocols. Document nursing encounters using the SOAP form of charting as required by policy and attend mandatory staff meetings and training. Communicate information to nursing staff, physician, health care unit supervisory personnel or other staff as necessary. Additional Details Deadline to apply to this position is April 22nd, 2026. Application deadline may be extended contingent upon applicants’ volume. ~~ Weekend availability required Qualifications & Requirements Education Graduate from an accredited school of nursing. Experience Prefer a minimum of one (1) year clinic experience Licenses/Certifications Have and maintain current licensure as a Registered Nurse within the state of employment. Must be able to obtain and maintain CPR certification. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.

Full-time

2 years ago

Registered Nurse (RN Nights)

Wellpath Castle Rock, CO

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference As a Registered Nurse (RN), your primary responsibility is to provide patient care using the nursing process of assessment, planning, implementation, and evaluation. You will work under the supervision of Charge Nurse(s) to provide patient education and activities in accordance with your competencies and education. This role requires excellent communication and critical thinking skills to ensure optimal patient outcomes. Key Responsibilities Assist in assessing and planning individual treatment programs, consulting with Charge Nurse(s) and other staff as necessary. Implement medical plans by administering medications, obtaining diagnostic tests, and assisting with medical or minor surgical procedures as needed. Count controlled substances and implement clinical and technical aspects of care in accordance with established policies, procedures, and protocols. Document nursing encounters using the SOAP form of charting as required by policy and attend mandatory staff meetings and training. Communicate information to nursing staff, physician, health care unit supervisory personnel or other staff as necessary. Additional Details Deadline to apply to this position is February 10th, 2026. Application deadline may be extended contingent upon applicants’ volume. Qualifications & Requirements Education Graduate from an accredited school of nursing. Experience Prefer a minimum of one (1) year clinic experience Licenses/Certifications Have and maintain current licensure as a Registered Nurse within the state of employment. Must be able to obtain and maintain CPR certification. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.

Full-time

2 years ago

Charge Registered Nurse (RN Nights)

Wellpath Castle Rock, CO

You Matter • Make a difference every day in the lives of the underserved• Join a mission driven organization with a people first culture• Excellent career growth opportunities Join us and find a career that supports: • Caring for overlooked, underserved, and vulnerable patients• Diversity, equity, inclusion, and belonging• Autonomy in a warm team environment• Growth and training Perks and Benefits In addition to comprehensive benefits including medical, dental, vision, paid time off, and 401k, we foster a work, life balance for team members and their family to support physical, mental, and financial wellbeing including: • DailyPay, receive your money as you earn it! • Tuition Assistance and dependent Scholarships• Employee Assistance Program (EAP) including free counseling and health coaching• Company paid life insurance• Tax free Health Spending Accounts (HSA)• Wellness program featuring fitness memberships and product discounts• Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. Why Us Now is your moment to make a difference in the lives of the underserved. If there is one unifying characteristic of everyone on our team, it is the deep desire to make a difference by helping society's most vulnerable and often overlooked individuals. Every day we have the distinct honor and responsibility to show up with non-judgmental compassion to provide hope and healing to those who need it most. For those whose calling it is to serve others, now is your moment to join our mission to provide quality care to every patient with compassion, collaboration, and innovation, to live our mantra to “Always Do The Right Thing!”, and to collectively do our part to heal the world, one patient at a time. Wellpath sees hundreds of thousands of unique individuals in their facilities month over month and a very large percent of those individuals receive direct clinical care, which includes lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical resources for training, education, and point of care support. How you make a difference The Charge Registered Nurse is responsible for overseeing the total health care delivery system in their assigned nursing unit, including the collection and evaluation of health status data, nursing diagnosis, goal setting, planning, implementation, and evaluation of patient care. They provide direct supervision of patient teaching and ensure that ancillary personnel only perform services for which they are qualified. The Charge RN is accountable for the overall quality of patient care in their assigned unit. Key Responsibilities Supervising the total health care delivery system in their assigned unit, ensuring compliance with policy and procedure, and coordinating patient care with other departments. Monitoring nursing service, maintain accurate records, and identify potential problems, proposing corrective actions as needed. Assisting with staff orientation, training, and evaluations, and coordinate staffing levels to meet contractual requirements. Ensuring the cleanliness, maintenance, and appearance of the unit and maintain appropriate levels of medical equipment and supplies. Maintaining a professional atmosphere and attend monthly staff meetings as directed by the Director of Nursing or Administrator. Additional Details Shift: Wed-Fri alternating Thur-Sat nights ~~ Additional shift differential for nights and weekends~~ Qualifications & Requirements Education Graduate of an accredited School of Nursing. Experience Prefer a minimum of one-year clinical experience. Licenses/Certifications Current licensure as a Registered Nurse within the state of employment. Current CPR Certification. We are an Equal Employment Opportunity Employer We are committed to fostering, cultivating, and preserving a culture of uniqueness. We celebrate a variety of backgrounds and are committed to creating an inclusive environment for all employees. We encourage you to apply! If you are excited about a role but your experience doesn’t seem to align perfectly with every element of the job description, we encourage you to apply. You may be just the right candidate for this, or one of our many other roles. Deadline to apply to this position is contingent upon applicant volume. Those positions located in Colorado will have a specific deadline posted in the job description. We are an Affirmative Action Employer in accordance with applicable state and local laws.

Nurse Manager (RN) - Behavioral Health Setting

UHS Superior, CO

Responsibilities Centennial Peaks Hospital has been providing psychiatric services to the Denver-metro area for more than 30 years. Located in beautiful Louisville, CO, our 104-bed facility provides a peaceful setting for those seeking treatment for mental illness including chemical dependency. Centennial Peaks offers unique and individualized programming for adolescents and adults that sets us apart from many other treatment facilities, and our dynamic leadership team includes a seasoned nursing department, ECT Therapy, Intensive Outpatient and Partial Hospitalization Programs. website: www.centennialpeaks.com The Nurse Manger is responsible for ensuring coordinated delivery of patient care in accordance with the established standards of care, mental health practice and hospital policy, goals and objectives. This position assists in contributing to the hospital’s philosophy, objectives, educational and Performance & Improvement efforts, while providing supervision of House Supervisors, RN’s and BHAs. This position will monitor staffing needs on assigned shifts. This position is responsible for assisting the CNO/ACNO in evaluating, reviewing, designing, and implementing hospital training events with respect to all RN/BHA staff required training. Also provides, on as-needed basis, patient nursing assessments. Participates in Treatment Team meetings as needed. Benefit and Reward Highlights: Tuition and Educational Reimbursement Program. Student Loan Repayment Program. Challenging and rewarding work environment Career development opportunities within UHS and its Subsidiaries Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans Discounts on pet insurance, automotive insurance & homeowners insurance 401(K) with company match and discounted stock plan Career development opportunities within UHS and its Subsidiaries SoFi Student Loan Refinancing Program More information is available on our Benefits Guest Website: benefits.uhsguest.com If you need assistance or would like to reach someone in the Human Resources department at Centennial Peaks please email: centennialpeakshumanresources@uhsinc.com . For full consideration, please apply directly to our website: https://jobs.uhsinc.com/centennial-peaks-hospital. Screening of applications begins immediately and continues until the position is filled. Qualifications Requirements: Education: Graduate from an accredited school of professional nursing required or equivalent combination of education and experience in nursing management; Bachelor’s Degree preferred. Experience: A minimum of (4) years of progressive nursing leadership experience, preferably in a psychiatric of behavioral healthcare setting. Experience in staff education and education concepts, practices and procedures and 24-hour shift staffing experience. Licensure: Current license to practice nursing in Colorado (or eligable to recieve or renew) Additional Requirements : Thorough knowledge of TJC, BHA, OSHA requirements, and state and federal regulatory requirements. CPR certification within 30 days of employment and successful completion of training in Crisis Prevention Intervention (or similar training). Certification training may be obtained during new hire orientation. About Universal Health Services One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500® corporation, annual revenues during 2025 were $17.4 billion. In 2026, UHS was again recognized as one of Fortune World’s Most Admired Companies™ and in 2025, was listed in Forbes ranking of America’s Largest Public Companies. Headquartered in King of Prussia, PA, UHS has approximately 101,500 employees and continues to grow through its subsidiaries. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 40 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom. For additional information visit www.uhs.com . EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. Avoid and Report Recruitment Scams We are aware of a scam whereby imposters are posing as Recruiters from UHS, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information. At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.