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Remote Utilization Review Nurse Jobs in Rio Rancho, 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 ... Such requests will be subject to review and approval by the Company, and exemptions will be granted ...

firsthand Health

Remote Triage Nurse

Albuquerque, NM · Remote

The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support to firsthand individuals and staff, while also supporting outpatient care coordination. This is ...

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Remote Utilization Review Nurse information

See Rio Rancho, NM salary details

$20

$40

$65

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

As of Aug 4, 2026, the average hourly pay for remote utilization review nurse in Rio Rancho, NM is $40.01, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $45.96 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a remote utilization review nurse?

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

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

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

What is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

More about Remote Utilization Review Nurse jobs
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:
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What job categories do people searching Remote Utilization Review Nurse jobs in Rio Rancho, NM look for? The top searched job categories for Remote Utilization Review Nurse jobs in Rio Rancho, NM are:
What cities near Rio Rancho, NM are hiring for Remote Utilization Review Nurse jobs? Cities near Rio Rancho, NM with the most Remote Utilization Review Nurse job openings:
Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Rio Rancho, NM as of July 2026, with employment types broken down into 2% As Needed, 62% Full Time, 16% Part Time, and 20% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $79,319 per year, or $38.1 per hour.

Infusion Referral Nurse Sr - REMOTE

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

$74K - $118K/yr

Full-time

Posted 7 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 110 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
Infusion Referral Nurse Sr - REMOTEJob Description
The Infusion Referral Nurse Sr is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site (e.g., home infusion) for drug infusion services versus the hospital outpatient facility. This role discusses financial and clinical considerations with members who are considering care at a higher cost treatment site, researches available financial programs to decrease members' out-of-pocket expense for drug services in office and coordinates lower cost site of service for drug administration if provider is referring due to convenience factors (e.g., distance, non-typical infusing provider, etc.).
Responsibilities
  • Provide site-of-service solutions for patients receiving care at non-preferred treatment locations, coordinating transitions to lower-cost alternatives (e.g., Hospital inpatient or outpatient facilities, non-pat cancer treatment centers, etc.)
  • Educate members and providers on the financial impact of specialty drugs, facilitating agreement on cost-effective treatment sites
  • Document and enter data following each case in web-based application and spreadsheets
  • Coordinate drug infusions and related services at alternate treatment sites to reduce overall healthcare costs
  • Support members with copay assistance programs and financial resources to minimize out-of-pocket expenses
  • Apply clinical knowledge and critical thinking to connect members with resources that optimize treatment outcomes
  • Maintain an active caseload, ensuring accurate documentation in web-based systems and spreadsheets in compliance with company policies and laws
  • Validate prior authorizations and site-of-service cases, synthesizing clinical data to support product initiatives and workflows
  • Other duties as assigned

Minimum Qualifications
  • Bachelors degree in Nursing or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required
  • 5 years of work experience in a clinical infusion setting
  • Current Registered Nurse (RN) license to practice in the applicable state(s)

Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
  • Ability to apply knowledge in relation to clinical findings from evidence-based guidelines
  • Ability to function independently and as a team member
  • Good organizational, time management and communication skills
  • Possess the ability to achieve organizational goals through development of effective teams
  • Comprehensive clinical knowledge of medical specialty drugs and the management of those drugs
  • Understanding of the clinical aspect of the infusion of those drugs within various sites of service

Preferred Qualifications
  • Experience in managed care, specialty drugs, care management and utilization review

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 $74,000.00 - $118,000.00 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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