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Remote Utilization Review Nurse Jobs in Rio Rancho, NM

ITW

National Sales Manager

NM · Remote

The role is a remote position; location base will be reviewed as this position covers all regions ... Enhance data utilization capabilities and enable stronger data led decision making in setting ...

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All JobsUtilization Review Nurse JobsRemote Utilization Review Nurse JobsRemote Utilization Review Nurse Jobs in Rio Rancho, NM

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 Jul 13, 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, and why are they important?

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 to make $300,000 as a nurse online?

A remote utilization review nurse can potentially earn $300,000 annually by gaining specialized certifications, gaining extensive experience, and working for high-paying healthcare organizations or as a contractor. Building a strong reputation and handling complex cases can also increase earning potential, often through overtime or consulting opportunities. However, reaching this income level typically requires advanced skills, a flexible schedule, and continuous professional development.

How do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing or case management. Many employers prefer candidates with knowledge of healthcare policies, insurance processes, and utilization review procedures, and some roles may require certification such as the Certified Professional in Healthcare Quality (CPHQ).

What does a remote utilization review nurse do?

A remote utilization review nurse evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They work remotely, often using electronic health records and communication tools, to ensure that patient care aligns with insurance or healthcare guidelines. Certification in case management or utilization review is typically required for this role.

How to become a remote nurse reviewer?

To become a remote utilization review nurse, candidates typically need a registered nurse (RN) license, relevant clinical experience, and knowledge of insurance or healthcare policies. Additional certifications such as Certified Case Manager (CCM) or Utilization Review Certification (URAC) can enhance prospects, and strong communication skills are essential for reviewing medical records and making determinations remotely.

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 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, 63% Full Time, 20% Part Time, and 15% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $83,222 per year, or $40 per hour.
Strategic Clinical Quality Manager - New Mexico/ El Paso Region

Strategic Clinical Quality Manager - New Mexico/ El Paso Region

Fresenius Medical Care

Albuquerque, NM • On-site, Remote

Full-time

Posted 23 days ago

Fresenius Medical Care rating

6.8

Company rating: 6.8 out of 10

Based on 1,291 frontline employees who took The Breakroom Quiz

491st of 882 rated healthcare providers

Job description

Position location: You will be able to work remotely, from your home location, in the United States
This is a remote opportunity within the Colorado/New Mexico operational area! The individual selected must reside in the Colorado/New Mexico Region. Travel required!
  • Monday-Friday schedule with no night or weekend shifts.
  • 80% Travel Required - multiple area assignments
  • Eligible for an annual bonus based on both company and individual performance.
  • Position covers all 3 modalities (incenter, inpatient, home therapies).
  • Chance to serve as a quality improvement subject matter expert.
  • Ability to have a significant influence in supporting clinics, patients, and care teams.
  • Career growth and advancement opportunities within the organization.

PURPOSE AND SCOPE:
The Clinical Quality Manager is responsible for developing, implementing, and monitoring quality assurance and performance improvement (QAPI) programs to ensure the highest standards of patient care and regulatory compliance. This role oversees clinical outcomes, coordinates quality initiatives, ensures adherence to regulations, and collaborates with the interdisciplinary team to drive continuous improvement in patient safety and clinical quality performance. The scope of the clinical quality oversight of the position covers assigned treatment modalities (e.g. in-center, home modalities, or home hemodialysis and home peritoneal dialysis)
PRINCIPAL DUTIES AND RESPONSIBILITIES:
  • Lead or participate in the clinic's Quality Assessment and Performance Improvement (QAPI) program in alignment with CMS, state, and organizational standards.
  • Develop and implement action plans to address deficiencies and improve care delivery.
  • Conduct regular audits and quality reviews to ensure compliance with clinical policies & procedures.
  • Facilitate staff education and training related to quality improvement, patient safety, and best practices.
  • Collaborate with physicians, nurses, dietitians, social workers, and leadership to support evidence-based clinical initiatives.
  • Prepare and present quality reports to clinic leadership and governing bodies.
  • Ensure accurate documentation, data collection, and reporting for internal and external stakeholders.
  • Promote a culture of accountability, safety, and continuous improvement within the clinic.
  • Manages the execution and achievement of Quality key performance indicators (assigned by Quality leadership team) and other clinical initiatives, interventions and standardized education materials with clinic teams within the assigned area(s).
  • Performs other related duties as assigned.

PHYSICAL DEMANDS AND WORKING CONDITIONS:
  • The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
    • Day-to-day work includes desk and personal computer work and interaction with facility staff and physicians.
  • The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials.
  • Field: The position requires travel between assigned facilities and various locations within the community, approx. 60%-80%.

• Travel to Regional, Division and Corporate meetings may be required.
  • Remote: The position could require travel up to 10-15%

SUPERVISION:
  • None

EDUCATION AND REQUIRED CREDENTIALS:
  • Registered Nurse required
  • BSN or bachelor's degree in healthcare-related field preferred (or equivalent experience).
  • Certification in Nephrology Nursing or quality preferred

EXPERIENCE AND SKILLS:
  • 3+ years of dialysis experience required.
  • 2+ years' experience in a leadership role.
  • Strong organizational, critical thinking and customer service skills.
  • Demonstrated leadership competencies and adaptability to changes in priorities
    • Ability to work collaboratively with other members of the team, gain support and input while participating in quality improvement activities.
  • Strong verbal and written communications skills.
  • Ability to analyze and propose alternate solutions, assist in resolving sensitive to complex issues

Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sexual orientation, gender identity, parental status, national origin, age, disability, military service, or other non-merit-based factors

What Fresenius Medical Care employees say

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About Fresenius Medical Care

Sourced by ZipRecruiter

We are a Team of more than 70,000 with one guiding Principle Patients First. This promise starts with providing the most comprehensive care for people living with Chronic Kidney Disease and extends to Innovative Solutions that are redefining Healthcare and setting the industry standard. From evolving home Dialysis and Patient education programs to improving patient care to providing World Class Research and Data driven insights. Our vertically integrated network tirelessly seeks new ways to improve the quality of our Patients' lives. We believe each of us can make an impact and together we can change an industry. Our Mission is to Provide Superior care that improves the quality of life of every patient, every day, setting the standard by which others in the Healthcare Industry are judged. And none of us does it alone. We bring together the brightest minds in kidney care to Dream, Research, and Innovate.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Waltham, MA, US

Year founded

1996

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