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Part Time Remote Utilization Review Nurse Jobs in Rio Rancho, NM

DataAnnotation

RN

Albuquerque, NM · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

DataAnnotation

RN

Rio Rancho, NM · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

DataAnnotation

LVN

Albuquerque, NM · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

DataAnnotation

LVN

Rio Rancho, NM · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

DataAnnotation

LPN

Albuquerque, NM · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

DataAnnotation

LPN

Rio Rancho, NM · Remote

$40 - $60/hr

MDs, PAs, and Nurses. Benefits ... This a full-time or part-time REMOTE position * You'll be able to choose which projects you want to ...

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Part Time Remote Utilization Review Nurse information

See Rio Rancho, NM salary details

$20

$39

$64

How much do part time remote utilization review nurse jobs pay per hour?

As of May 29, 2026, the average hourly pay for part time remote 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 are the key skills and qualifications needed to thrive as a Part Time Remote Utilization Review Nurse, and why are they important?

To thrive as a Part Time Remote Utilization Review Nurse, you need an active RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical coding systems (like ICD-10 and CPT), healthcare management software, and payer guidelines is often required. Excellent written communication, attention to detail, and the ability to work independently are essential soft skills for remote success. These competencies ensure accurate review of medical records, compliance with regulations, and effective coordination with healthcare teams while working remotely.

How do part-time remote Utilization Review Nurses typically collaborate with physicians and other healthcare professionals?

Part-time remote Utilization Review Nurses often communicate with physicians, case managers, and insurance representatives through secure digital platforms, emails, and scheduled virtual meetings. They review patient records and coordinate care authorizations, frequently clarifying clinical information or policy requirements with providers. Balancing asynchronous communication and timely responses is essential, as collaboration impacts both patient outcomes and reimbursement processes. Building strong professional relationships and maintaining clear documentation are key to effective teamwork in this remote setting.

What does a Part Time Remote Utilization Review Nurse do?

A Part Time Remote Utilization Review Nurse evaluates medical records and treatment plans to ensure that healthcare services are medically necessary and comply with insurance guidelines. Working remotely, they review patient cases, communicate with healthcare providers, and make recommendations on the appropriateness of care. Their role helps manage healthcare costs and ensures patients receive appropriate care while adhering to regulatory and insurance standards.

What is the difference between Part Time Remote Utilization Review Nurse vs Part Time Remote Case Manager?

AspectPart Time Remote Utilization Review NursePart Time Remote Case Manager
CredentialsRN license, certifications in utilization review (e.g., CUC, URAC)RN or social work license, case management certification (e.g., CCM)
Work EnvironmentRemote, reviewing medical records and authorizationsRemote, coordinating care and discharge planning
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsInsurance companies, healthcare organizations, managed care firms

The Part Time Remote Utilization Review Nurse primarily evaluates medical necessity for insurance approvals, focusing on documentation review. In contrast, the Part Time Remote Case Manager manages patient care plans, coordinating services and discharge planning. Both roles are remote, require healthcare credentials, and are common in the insurance and healthcare industries, but they differ in daily responsibilities and focus areas.

What are popular job titles related to Part Time Remote Utilization Review Nurse jobs in Rio Rancho, NM? For Part Time Remote Utilization Review Nurse jobs in Rio Rancho, NM, the most frequently searched job titles are:
What job categories do people searching Part Time Remote Utilization Review Nurse jobs in Rio Rancho, NM look for? The top searched job categories for Part Time Remote Utilization Review Nurse jobs in Rio Rancho, NM are:
What cities near Rio Rancho, NM are hiring for Part Time Remote Utilization Review Nurse jobs? Cities near Rio Rancho, NM with the most Part Time Remote Utilization Review Nurse job openings:
Part Time Remote Utilization Review Nurse jobs near you
Infographic showing various Part Time Remote Utilization Review Nurse job openings in Rio Rancho, NM as of May 2026, with employment types broken down into 3% As Needed, 79% Full Time, 15% Part Time, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $82,723 per year, or $39.8 per hour.
Physician Clinical Reviewer - Urology- REMOTE

Physician Clinical Reviewer - Urology- REMOTE

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

$90.87 - $154.33/hr

Part-time

Posted 17 days ago

Prime Therapeutics rating

8.0

Company rating: 8.0 out of 10

Based on 43 frontline employees who took The Breakroom Quiz

14th of 97 rated pharmacies

Job description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting Title
Physician Clinical Reviewer - Urology- REMOTEJob Description
Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required.
Responsibilities
Physician Clinical Reviewer - Job Description Responsibilities
  • Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer.
  • Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax.
  • Provides clinical rationale for standard and expedited appeals.
  • Provides assistance and acts as a resource to Initial Clinical Reviewers as needed to discuss cases and problems.
  • Utilizes medical/clinical review guidelines and parameters to assure consistency in the physician review process so as to reflect appropriate utilization and compliance with Prime's policies/procedures, as well as URAC and NCQA guidelines.
  • Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner.
  • Participates in on-going inter-rater reliability training and testing
  • Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.
  • On a requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions.
  • On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the VP, Medical Director
  • Other duties as assigned.

Education & Experience
  • Education Level
    • DO
    • MBBS
    • MD
  • Required
    • Yes
    • Yes
    • Yes
  • Fields of Study
  • Experience Level
    • 5+ years
  • Required
    • Yes
  • Details
    • Clinical

Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Additional Qualifications
Preferred Qualifications
Physical Demands
  • Must be able to remain in a stationary position 50% of the time. Must be able to "move or traverse"
  • Must be able to constantly operate a computer and/or other office productivity equipment
  • Must be able to hear and constantly communicate information and ideas. Must be able to exchange accurate information
  • Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
Potential pay for this position ranges from $90.87 - $154.33 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.

What Prime Therapeutics employees say

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About Prime Therapeutics

Sourced by ZipRecruiter

Prime Therapeutics, located in Eagan, MN, is a pharmacy benefits management company that has been serving the healthcare industry since its foundation. They are an integral participant in the medical sector, specifically in the realm of health insurance. They focus on providing innovative pharmacy benefits and services to more than 30 million members nationwide. Besides their main pharmacy benefit management, they offer mail service pharmacy, specialty pharmacy, benefits management, and consultative engagement services to ensure individuals have continuous access to affordable prescription drugs. Prime Therapeutics, founded around three decades ago, has grown to stand out as a leader in its industry, thanks to its commitment to improving the health of its clients.

Industry

Insurance services

Company size

1,001 - 5,000 Employees

Headquarters location

Eagan, MN, US

Year founded

1987

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