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Utilization Review RN
Company : Catholic Health Initiatives
Location : Centennial, CO
Job Type : Full Time / Part Time
Salary : 34.14-54.46 HOUR
Date Posted : 31 December 2025
Job Summary and Responsibilities
You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills – but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success.
The Utilization Review RN is responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking.
Additionally, as a Utilization Review RN, you will collaborate with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.
Schedule: Days (8:00am - 4:30pm) 7-days/week, Remote.
Job Requirements
In addition to bringing humankindness to the workplace each day, qualified candidates will need the following:
- Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.
- Utilization Review experience strongly preferred.
- Preferred graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or related healthcare field.
- At least five (5) years of nursing experience
- RN license in the state(s) covered is required.
Physical Requirements - Medium Work - (Exert up to 50lbs force occasionally, and/or up to 20lbs frequently, and/or up to 10lbs constantly)
Where You'll WorkWe believe in the healing power of humanity and serving the common good through our dedicated work and shared mission to celebrate humankindness.
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Frequently asked questions
In Centennial, a Utilization Review RN plays a crucial role in securing inpatient authorizations and ensuring ongoing stay approvals by coordinating with insurance providers. This involves verifying payer sources and guiding payer communication staff, which is essential for smooth patient admissions and continued hospitalization.
Remote Utilization Review RNs at Catholic Health Initiatives must balance thorough case reviews with effective virtual collaboration among physicians and care teams. They navigate complex insurance policies and denial prevention strategies while maintaining team cohesion and adhering to evidence-based guidelines from a distance.
A Utilization Review RN in Colorado typically requires an active RN license in the state, at least five years of nursing experience, and strong utilization review expertise. Mastery of clinical evaluation and payer coordination distinguishes this role from bedside nursing, emphasizing case management and regulatory compliance.
Certifications like Certified Case Manager (CCM) or Certified Utilization Review Professional (CURP) are highly regarded in Centennial, enhancing credibility in payer negotiations and clinical reviews. These credentials reflect proficiency in utilization management, which is especially valued by employers like Catholic Health Initiatives.
Utilization Review RNs in Centennial generally earn between $75,000 and $95,000 annually, influenced by experience and certifications. Remote roles with organizations such as Catholic Health Initiatives may offer competitive compensation aligned with regional healthcare standards and nursing expertise.
Catholic Health Initiatives embeds Utilization Review RNs within a compassionate framework, valuing their critical thinking and teamwork to ensure patients receive appropriate care. This role supports the organization’s mission by promoting ethical utilization of resources and fostering a caring, supportive workplace culture.
At Catholic Health Initiatives, Utilization Review RNs benefit from a collaborative environment emphasizing leadership support and professional growth. Their responsibilities extend beyond record review to include denial root cause analysis and payer communication, creating a uniquely comprehensive case management experience.
Centennial’s job market for Utilization Review RNs is moderately competitive, with steady demand driven by regional healthcare expansion. While Denver offers more opportunities, Centennial provides a balanced hiring pace with attractive conditions for nurses seeking remote or day-shift schedules.
Daily duties include evaluating patient records for admission appropriateness, coordinating with physicians, managing insurance authorizations, and collaborating with denial prevention teams. Remote work requires strong communication skills to maintain alignment with onsite staff and ensure timely, accurate case assessments.