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Remote Utilization Management Jobs in Albuquerque, NM

firsthand Health

Remote Triage Nurse

Albuquerque, NM · On-site +1

$80K/yr

... are utilization. Together with our health plan partners, we are changing the way our society ... When not managing acute issues, Triage Nurses focus on care coordination, training, and related ...

ABB

Utility Sales Support

NM · Remote

$17.75 - $23.25/hr

... management with local business units and other ABB groups. Additionally, the role will expand to ... While this is a remote position, candidates must be located in the United States. You will be ...

RE/SPEC Inc.

AIX Developer

Albuquerque, NM · Remote

Depending on your expertise, you might design infrastructure in remote locations, develop renewable ... Monitor AIX server health, resource utilization, and application performance, proactively ...

RE/SPEC Inc.

AIX Developer

Albuquerque, NM · On-site +1

Depending on your expertise, you might design infrastructure in remote locations, develop renewable ... Monitor AIX server health, resource utilization, and application performance, proactively ...

RE/SPEC Inc.

AIX Developer

Albuquerque, NM · Remote

Depending on your expertise, you might design infrastructure in remote locations, develop renewable ... Monitor AIX server health, resource utilization, and application performance, proactively ...

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Remote Utilization Management information

See Albuquerque, NM salary details

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$40

$66

How much do remote utilization management jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for remote utilization management 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 remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What are the key skills and qualifications needed to thrive in remote utilization management?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

How does a remote utilization management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

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

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

What are popular job titles related to Remote Utilization Management jobs in Albuquerque, NM?

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

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

The top searched job categories for Remote Utilization Management jobs in Albuquerque, NM are:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Albuquerque, NM as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 82% Physical, 2% Hybrid, and 16% Remote job distribution, with an average salary of $85,249 per year, or $41 per hour.

LTC Utilization Management Reviewer

Presbyterian Healthcare Services

Albuquerque, NM • On-site, Remote

$65K - $111K/yr

Full-time

Medical, Dental, Vision, Life

Posted 8 days ago

Presbyterian Healthcare Services rating

7.2

Company rating: 7.2 out of 10

Based on 164 frontline employees who took The Breakroom Quiz

345th of 893 rated healthcare providers

Job description

Location Address:
9521 San Mateo NEAlbuquerque, NM 87113-2237
Compensation Pay Range:
Minimum Offer $65,520.00Maximum Offer $111,612.80Now Hiring: LTC Utilization Management Reviewer
Summary:
Build your Career. Make a Difference. Presbyterian is hiring a skilled LTC Utilization Management Reviewer to join our team.Type of Opportunity: Full timeJob Exempt: YesJob is based: Reverend Hugh Cooper Administrative CenterWork Shift: Days (United States of America)
Responsibilities:
Now hiring a Utilization Management Reviewer-LTC
Responsible for conducting Nursing (NF) Facility Level of Care (LOC) determinations according to state regulations and criteria. Performs utilization review activities to ensure that services rendered to members meet Long Term Care Supports and Services (LTSS) criteria and services are delivered in the appropriate setting. Utilizes LTSS skills and established criteria to review, coordinate, document and approve all aspects of the utilization/benefit management program, including but not limited to community benefit care plans and self-directed community benefit care plans and budgets. Validates and interprets documentation using approved LTSS criteria. Consults with PHP medical directors and refers for medical director decisions on cases not meeting LTSS criteria, NF LOC denials and care plans that result in a reduction in service or benefit denial. Refers cases for Quality Management review and Special Investigative Review as indicated for quality of care issues and possible abuse/fraud
Some key responsibilities include:
  • NF LOC evaluations and determinations,
  • Responsible for the review of all required medical documentation against HSD criteria and to provide an objective evaluation and determination of NF LOC medical eligibility (approvals and denials).
  • Documents recommendations and NF LOC determinations (approvals, request for more information and denials in PHPs case management system, including appropriate documentation of authorization and NF LOC begin and end date eligibility spans according to established HSD policies. Refers all NF LOC denials to the health plans medical director for review.
  • Prepares files and participates in state fair hearing procedures.
  • Reviews agency-based community benefit care plans for appropriateness according to established LTC benefit UM criteria and guidelines and according to required timelines. Approves (full or partial) or denies care plan according to criteria and available documentation
  • Documents Agency-based community benefit care plan approvals, partial approvals and denials in PHPs case management system according to policies and procedures and job-aids.
  • Reviews self-directed community benefit care plans and budgets for appropriateness according to established LTC benefit UM criteria and guidelines and according to required timelines. Approves (full or partial) or denies care plan according to criteria and available documentation
  • Reviews care plans to assure the overall cost of the community benefit care plan does not exceed the overall cost of care in a nursing home based on the benchmark provided by HSD.
  • Documents self-directed community benefit care plan and budget approvals, partial approvals and denials in PHPs case management system and the Fiscal Management agencys information system according to policies and procedures and job-aids.

Qualifications:
  • Active Nursing license in NM or compact license (RN or LPN) with a minimum of one year of relevant experience
  • Medical Social Worker with a minimum of one year of relevant experience; or
  • Physical, Occupational, or Rehab Therapists with a minimum of one year of relevant experience.
  • Prefer 1 year of experience in MCO, health plan insurance environment , with expertise performing utilization management or experience working in long term care services
  • Knowledge of all state and federal regulations concerning the use, disclosure, and confidentiality of all patient records.
  • Analytical skills as applicable to interpret provider communication and medical records.
  • Attention to detail and organizational skills.
  • Ability to articulate orally and in writing an understanding of complex issues and detailed action plans, while best
  • representing the organization professionally.
  • Ability to work cooperatively with other employees and departments.
  • Efficient and comfortable with computer electronic data entry and documentation
  • Ability to succinctly document using correct spelling and grammar.
  • Able to summarize from medical clinical notes, progress notes, needs assessments, functional assessments, progress notes, history and physicals , care plans and other state required documentation.
  • Able to meet timelines and deadlines associated with work load.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

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About Presbyterian Healthcare Services

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Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Albuquerque, NM, US

Year founded

1908

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