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Remote Utilization Review Nurse Jobs in Rio Rancho, NM

ZOLL Medical

Patient Service Representative

Albuquerque, NM · Remote

$17 - $21.50/hr

Patient Service Representative (PSR) Remote independent contract worker position Competitive fee ... LPN, MA, Phlebotomy, RCIS, CVT, EKG Technician, etc. All candidates reviewed on an individual ...

ZOLL LifeVest

Patient Service Representative

Albuquerque, NM · Remote

$17 - $21.50/hr

Patient Service Representative (PSR) Remote independent contract worker position Competitive fee ... LPN, MA, Phlebotomy, RCIS, CVT, EKG Technician, etc. All candidates reviewed on an individual ...

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

Remote Utilization Review Nurse information

See Rio Rancho, NM salary details

$19

$38

$62

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

As of Jun 10, 2026, the average hourly pay for remote utilization review nurse in Rio Rancho, NM is $38.13, according to ZipRecruiter salary data. Most workers in this role earn between $30.14 and $43.80 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 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
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Remote Utilization Review Nurse jobs near you
Strategic Clinical Quality Manager - Colorado/New Mexico Region

Strategic Clinical Quality Manager - Colorado/New Mexico Region

Fresenius Medical Care

Albuquerque, NM • On-site, Remote

$72K - $121K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 19 days ago

Fresenius Medical Care rating

6.7

Company rating: 6.7 out of 10

Based on 1,265 frontline employees who took The Breakroom Quiz

526th of 870 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!
80% Travel Required - multiple area assignments
Position covers all 3 modalities
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

The rate of pay for this position will depend on the successful candidate's work location and qualifications, including relevant education, work experience, skills, and competencies.
Annual Rate: $72,900.00 - $121,600.00 for Pueblo, CO location
Benefit Overview: This position offers a comprehensive benefits package including medical, dental, and vision insurance, a 401(k) with company match, paid time off, parental leave.
If your location allows for pay/benefit transparency, please click the link below to request further information on this position.
Pay Transparency Request Form
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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Hours and flexibility

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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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