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How much do contract utilization review jobs pay per hour?

As of Jul 11, 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:
What are popular job titles related to Contract Utilization Review jobs in Rio Rancho, NM? For Contract Utilization Review jobs in Rio Rancho, NM, the most frequently searched job titles are:
What job categories do people searching Contract Utilization Review jobs in Rio Rancho, NM look for? The top searched job categories for Contract Utilization Review jobs in Rio Rancho, NM are:
What cities near Rio Rancho, NM are hiring for Contract Utilization Review jobs? Cities near Rio Rancho, NM with the most Contract Utilization Review job openings:
Contract Utilization Review jobs near you
(RN)Auditor, Healthcare Services - NCQA

(RN)Auditor, Healthcare Services - NCQA

Molina Healthcare

Rio Rancho, NM • On-site

$29.05 - $56.64/hr

Full-time

Posted 26 days ago

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

134th of 281 rated insurance

Job description

JOB DESCRIPTION 

Job Summary

Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. This role supports the New Mexico Turquoise Care Contract. 
 

Essential Job Duties

• Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed. 
• Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met. 
• Assesses clinical staff regarding appropriate clinical decision-making. 
• Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership. 
• Ensures auditing approaches follow a Molina standard in approach and tool use. 
• Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications. 
• Adheres to departmental standards, policies and protocols. 
• Maintains detailed records of auditing results. 
• Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results. 
• Meets minimum production standards related to clinical auditing. 
• May conduct staff trainings as needed. • Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct. 
 

Required Qualifications

• At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience. 
• Registered Nurse (RN). License must be active and restricted in state of practice. 
• Strong attention to detail and organizational skills. 
• Strong analytical and problem-solving skills. 
• Ability to work in a cross-functional, professional environment. 
• Ability to work on a team and independently. 
• Excellent verbal and written communication skills. 
• Microsoft Office suite/applicable software program(s) proficiency. 
 

Preferred Qualifications

Prior experience in clinical review/auditing of care management.

Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or  IPRO. 

Analytical ability to review data and determine quality trends. 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $29.05 - $56.64 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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