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Home Based Utilization Review Nurse Jobs in Rio Rancho, NM

w3r Consulting

Utilization Review Nurse

Albuquerque, NM · On-site

Registered Nurse responsible for collaborating with healthcare providers, members, and business ... home health, durable medical equipment and out of network services. Conduct reviews in compliance ...

UnitiMed

RN Case Manager

Albuquerque, NM · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the ... based on nationally published GSA rates. Actual weekly pay and per diems may differ from the amount ...

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All JobsHome Based Utilization Review Nurse JobsHome Based Utilization Review Nurse Jobs in Rio Rancho, NM

Home Based Utilization Review Nurse information

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$39

$64

How much do home based utilization review nurse jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for home based utilization review nurse 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 is the difference between Home Based Utilization Review Nurse vs Telehealth Nurse?

AspectHome Based Utilization Review NurseTelehealth Nurse
CredentialsRN license, possibly certifications in case management or utilization reviewRN license, may have certifications in telehealth or specialty areas
Work EnvironmentHome office, reviewing patient cases remotely for insurance or healthcare providersRemote or clinical setting providing patient care via telecommunication tools
Employer & IndustryInsurance companies, healthcare organizations, utilization review firmsHospitals, clinics, telehealth companies, healthcare providers

The Home Based Utilization Review Nurse primarily focuses on reviewing patient cases remotely to determine appropriate care and resource utilization, often for insurance purposes. In contrast, the Telehealth Nurse provides direct patient care via telecommunication platforms, offering advice, education, and clinical support. While both roles are remote and require nursing credentials, their core responsibilities and work environments differ significantly.

What are the key skills and qualifications needed to thrive as a Home Based Utilization Review Nurse, and why are they important?

To thrive as a Home Based Utilization Review Nurse, you need a valid RN license, clinical experience, and a strong understanding of medical necessity criteria and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory standards such as Medicare or Medicaid are typically required. Critical thinking, attention to detail, and effective communication are standout soft skills for this role. These skills ensure accurate case assessments, compliance with policies, and effective collaboration, which are vital for optimizing patient outcomes and healthcare resource utilization.

What are Home Based Utilization Review Nurses?

Home Based Utilization Review Nurses are registered nurses who work remotely, typically from their homes, to evaluate the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records, coordinate with healthcare providers, and ensure that patient care meets established guidelines and insurance requirements. These nurses play a crucial role in managing healthcare costs and improving patient outcomes by ensuring that patients receive the right level of care. They often interact with insurance companies, healthcare facilities, and patients to facilitate approvals and appeals for medical services.

How does a Home Based Utilization Review Nurse typically collaborate with physicians and care teams while working remotely?

As a Home Based Utilization Review Nurse, collaboration with physicians and interdisciplinary care teams is primarily conducted through secure digital platforms, phone calls, and video meetings. You will review patient records, discuss care plans, and provide recommendations to ensure appropriate resource utilization. Effective communication skills are essential, as you'll need to clearly convey clinical findings and advocate for necessary services while balancing payer guidelines. Building strong virtual relationships and staying organized with documentation are key to overcoming the challenges of remote teamwork.
What are the most commonly searched types of Utilization Review Nurse jobs in Rio Rancho, NM? The most popular types of Utilization Review Nurse jobs in Rio Rancho, NM are:
What are popular job titles related to Home Based Utilization Review Nurse jobs in Rio Rancho, NM? For Home Based Utilization Review Nurse jobs in Rio Rancho, NM, the most frequently searched job titles are:
What job categories do people searching Home Based Utilization Review Nurse jobs in Rio Rancho, NM look for? The top searched job categories for Home Based Utilization Review Nurse jobs in Rio Rancho, NM are:
Home Based Utilization Review Nurse jobs near you
Infographic showing various Home Based Utilization Review Nurse job openings in Rio Rancho, NM as of June 2026, with employment types broken down into 1% As Needed, 90% Full Time, 8% Part Time, and 1% Contract. Highlights an 86% Physical, 1% Hybrid, and 13% Remote job distribution, with an average salary of $82,723 per year, or $39.8 per hour.
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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