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Part Time Remote Utilization Review Jobs in Albuquerque, NM

Booz Allen Hamilton, Inc.

Systems Engineer

Albuquerque, NM · On-site +1

$52K - $108K/yr

Remote Work: Hybrid Job Number: R0242699 Location: Albuquerque,NM,US Share job via: Share Systems ... Full-time and part-time employees working at least 20 hours a week on a regular basis are eligible ...

Booz Allen Hamilton, Inc.

Systems Engineer

Albuquerque, NM · On-site +1

$86K - $198K/yr

Remote Work: Hybrid Job Number: R0242692 Location: Albuquerque,NM,US Share job via: Share Systems ... Full-time and part-time employees working at least 20 hours a week on a regular basis are eligible ...

Food and Water Watch

New Mexico Organizer

Albuquerque, NM · On-site +1

$23/hr

This position is primarily remote. However, the employee may be required to occasionally report to ... This is a part-time temporary grant-funded position for a one year term; this position is hourly ...

Booz Allen Hamilton, Inc.

Data Architect

Albuquerque, NM · On-site +1

$61.75 - $79.50/hr

Remote Work: No Job Number: R0236266 Location: Albuquerque,NM,US Share job via: Share Data ... Full-time and part-time employees working at least 20 hours a week on a regular basis are eligible ...

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All JobsUtilization Review JobsPart Time Remote Utilization Review JobsPart Time Remote Utilization Review Jobs in Albuquerque, NM

Part Time Remote Utilization Review information

See Albuquerque, NM salary details

$20

$40

$66

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

As of Aug 18, 2026, the average hourly pay for part time remote utilization review in Albuquerque, NM is $40.99, according to ZipRecruiter salary data. Most workers in this role earn between $32.40 and $47.07 per hour, depending on experience, location, and employer.

What is a part time remote utilization review?

A Part Time Remote Utilization Review position involves evaluating medical records and healthcare services to ensure they are necessary and appropriate, typically for insurance companies or healthcare providers. This job is performed remotely, allowing professionals to work from home or another location outside of a traditional office setting. Part-time roles generally require fewer hours than full-time positions, making them suitable for those seeking flexible schedules. Professionals in this role often have backgrounds in nursing or healthcare and use their expertise to review patient care for quality and cost-effectiveness.

What skills and qualifications are needed for a part time remote utilization review?

To thrive as a Part Time Remote Utilization Review Nurse, you need a current RN license, strong clinical judgment, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and systems such as InterQual or MCG is typically required. Excellent communication, critical thinking, and self-motivation are vital soft skills for coordinating care and making independent decisions remotely. These skills ensure accurate case evaluations, regulatory compliance, and effective collaboration with healthcare teams while working from a remote setting.

What challenges do part time remote utilization review professionals face, and how can they be managed?

Part-time remote utilization review professionals often face challenges such as balancing a variable workload, ensuring timely communication with healthcare providers, and staying current with changing insurance guidelines. Since much of the work is done independently, strong time management and self-motivation are essential to meet review deadlines. Regularly scheduled check-ins with the team and utilizing digital collaboration tools can help maintain connectivity and support. Staying organized and proactive in seeking clarification when needed can mitigate common challenges and lead to a successful experience in this role.

What is the difference between Part Time Remote Utilization Review vs Part Time Remote Claims Reviewer?

AspectPart Time Remote Utilization ReviewPart Time Remote Claims Reviewer
CredentialsTypically requires healthcare licenses (e.g., RN, MD) and utilization review certificationsUsually requires insurance or claims processing experience, with some industry-specific certifications
Work EnvironmentRemote, healthcare-focused, reviewing medical necessity and appropriateness of careRemote, insurance or healthcare claims processing, verifying coverage and claims accuracy
Employer & Industry UsageHospitals, insurance companies, healthcare organizationsInsurance companies, third-party administrators, healthcare payers

Part Time Remote Utilization Review and Part Time Remote Claims Reviewer both operate remotely but focus on different aspects of healthcare administration. Utilization reviewers assess medical necessity, while claims reviewers verify insurance claims. Understanding these differences helps job seekers find roles aligned with their skills and credentials.

What are the most commonly searched types of Remote Utilization Review jobs in Albuquerque, NM?

The most popular types of Remote Utilization Review jobs in Albuquerque, NM are:

What are popular job titles related to Part Time Remote Utilization Review jobs in Albuquerque, NM?

For Part Time Remote Utilization Review jobs in Albuquerque, NM, the most frequently searched job titles are:

What job categories do people searching Part Time Remote Utilization Review jobs in Albuquerque, NM look for?

The top searched job categories for Part Time Remote Utilization Review jobs in Albuquerque, NM are:

Part Time Remote Utilization Review jobs near you
Infographic showing various Part Time Remote Utilization Review job openings in Albuquerque, NM as of August 2026, with employment types broken down into 100% Part Time. Highlights an 100% Remote job distribution, with an average salary of $85,249 per year, or $41 per hour.

Physician Clinical Reviewer -Psychiatry- REMOTE

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

$90.87 - $154.33/hr

Part-time

Posted 13 days ago

Prime Therapeutics rating

7.9

Company rating: 7.9 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

16th of 112 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 -Psychiatry- REMOTEJob Description
The Physician Clinical Reviewer is a 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. This role 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
  • 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

Minimum Qualifications
  • Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO) or Bachelor of Medicine, Bachelor of Surgery (MBBS) international degree with successful completion of United States based internship and residency (and successful completion of United States based fellowship for subspecialists) required
  • Current, unrestricted license to practice medicine in one or more states of the United States
  • Board Certified by one of the following: American Board of Medical Specialties (ABMS), American Board of Osteopathic Specialties (ABOS), American Board of Internal Medicine or American Board of Osteopathic Internal Medicine (ABIM/ABOIM)
  • 1 year of work experience in clinical review

Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Additional Qualifications
  • Familiarity with the principles and procedures of utilization management as practiced in managed care organizations

Preferred Qualifications
  • Medicare Part D experience.
  • Experience with cost benefit analysis, quality assurance and the continuous quality improvement process

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
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job
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.

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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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