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Contract Utilization Review Jobs in Rio Rancho, NM

Encompass Health

Case Manager

Albuquerque, NM · On-site

$19.50 - $25/hr

Understand commercial contract levels, exclusions, payor requirements, and recertification needs ... Participate in utilization review process: data collection, trend review, and resolution actions.

Encompass Health

Case Manager

Albuquerque, NM

$19.50 - $25/hr

Understand commercial contract levels, exclusions, payor requirements, and recertification needs ... Participate in utilization review process: data collection, trend review, and resolution actions.

Encompass Health Corporation

Case Manager

Albuquerque, NM · On-site

$18.25 - $23.50/hr

Understand commercial contract levels, exclusions, payor requirements, and recertification needs ... Participate in utilization review process: data collection, trend review, and resolution actions.

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All JobsContract Utilization Review JobsContract Utilization Review Jobs in Rio Rancho, NM

Contract Utilization Review information

See Rio Rancho, NM salary details

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$39

$64

How much do contract utilization review jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for contract utilization review in Rio Rancho, NM is $39.77, according to ZipRecruiter salary data. Most workers in this role earn between $31.44 and $45.67 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Contract Utilization Review position, and why are they important?

To thrive in Contract Utilization Review, you need a solid understanding of medical terminology, insurance policies, and contract compliance, often supported by a healthcare-related degree or certification in utilization management. Familiarity with utilization review software, electronic medical records (EMR), and knowledge of regulatory standards such as CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication skills are crucial for collaborating with care teams and insurers. These abilities ensure reviews are accurate, contracts are properly administered, and patient care meets organizational and payer requirements.

What does a typical day look like for someone working in Contract Utilization Review?

A typical day in Contract Utilization Review involves reviewing patient medical records, ensuring adherence to payer contracts and regulatory standards, and communicating with healthcare providers to validate medical necessity of services. Professionals in this role often collaborate with clinical staff, case managers, and insurance representatives to resolve discrepancies or authorization issues. The work is detail-oriented and deadline-driven, making organizational skills vital. This dynamic position offers significant opportunities to learn more about healthcare regulations and may serve as a stepping stone toward more advanced roles in healthcare administration or compliance.

What is a Contract Utilization Review job?

A Contract Utilization Review job involves analyzing and evaluating the usage of contracts to ensure compliance, cost-effectiveness, and efficiency. Professionals in this role review contract terms, monitor vendor performance, and assess utilization data to optimize contract value. They may work in industries such as healthcare, government, or procurement, ensuring that agreements are being properly executed. The goal is to identify areas for improvement, reduce waste, and enhance operational efficiency.

What are the most commonly searched types of Utilization Review jobs in Rio Rancho, NM? The most popular types of Utilization Review jobs in Rio Rancho, NM are:
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Contract Utilization Review jobs near you
Utilization Review Nurse

Utilization Review Nurse

w3r Consulting

Albuquerque, NM • On-site

Full-time

Posted 25 days ago

Job description

Description:
Registered Nurse responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: drugs and biologics, inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts.
Essential Duties and Responsibilities:
• Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.
• Uses an established set of criteria to evaluates and authorize the medical necessity of services.
• Provide notification of decisions in accordance with compliance guidelines.
• Coordinate with Medical Directors when services do not meet criteria or require additional review.
• Participation in staff meetings, regular trainings and other collaborative meetings as appropriate.
• Works with management team to achieve operational objectives and financial goals.
• Supports teams across UM Department as needed.
• Active participation and completion of all required trainings.
• Maintain Required Licensures.
• Adherence to regulatory and departmental timeframes for review of requests
• Meet/exceed department Turn Around time, daily established productivity goals, and service levels
• Proficient knowledge of policies and procedures, Medicare, HIPPA and NCQA standards;
• Professional demeanor and the ability to work effectively within a team or independently;
• Flexible with the ability to shift priorities when required
• Other duties as required
Qualifications:
• Current unrestricted RN license. Multi-State License Preferred
• Bachelors degree in nursing or health-care related field preferred
• Minimum of 2 years experience in a regulated environment preferred
• Minimum of 2-3 years clinical experience
• Strong customer orientation
• Strong organizational, planning, and communication skills
• Working knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10), and overall claims process a plus
• Knowledge of National Coverage Determinations, Local Coverage Determinations and MCG criteria are a plus.
• Excellent time management skills
Knowledge, Skills, Abilities Required:
• Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
• Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
• Able to work in a dynamic, fast-paced team environment and to promote team concepts
• Excellent typing skills.
• Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.

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