RN Utilization Review Coordinator

Job Description

Job Description

Description :

RN Utilization Review Coordinator

Reports to : Medical Director

Job Category : Hourly | Non-Exempt | Full-Time

Starting Salary : $34-$51 / hour (DOE and licensure)

Job Site : Hybrid (Broomfield, CO office / Home office)

Job Summary :

The Registered Nurse (RN) Utilization Review Coordinator plays a critical role in overseeing the clinical admission process and ensuring appropriate utilization of detox and residential treatment services. This position serves as the clinical decision-maker for all incoming admissions, verifying medical and psychiatric appropriateness, reviewing clinical documentation, and coordinating with referring providers, intake staff, and internal teams to ensure timely, safe, and clinically appropriate admissions. Additionally, the RN manages ongoing utilization review (UR) to maintain compliance with payer requirements and to support quality client care throughout the treatment continuum.

Education and Experience :

• Current, unrestricted nursing license in Colorado (registered with DORA).
• RN, LPN Diploma, Associates, or Bachelors in Nursing; BSN preferred.
• Minimum two (2) years of experience in psychiatric, behavioral health, or substance use treatment.
• Strong knowledge of ASAM criteria and medical necessity standards for detox and residential levels of care.
• Prior experience with utilization review and insurance authorizations.
• Experience in a detox, dual-diagnosis, or residential treatment setting preferred.
• Familiarity with managed care requirements and UR software platforms preferred.
• BLS certification required.

Required Skills / Abilities :

Duties / Responsibilities :

Review all incoming admission referrals for clinical and medical appropriateness.

Conduct concurrent and retrospective utilization reviews to ensure services meet payer and regulatory standards.

Provide nursing assessments, medication reconciliation, and clinical input as needed during the admission process.

Physical Requirements :

Benefits & Perks : Health and Wellness

Financial

Work / Life Perks

This description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.

Requirements :