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Remote Utilization Review Rn 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 ... The Triage Nurse is a remote Registered Nurse who provides telephone and electronic triage support ...

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 ...

Varsity Tutors

NCLEX-RN Tutor

Albuquerque, NM · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Scribe-X

Medical Scribe (Remote)

Albuquerque, NM · Remote

$14 - $17/hr

Anyone looking to begin a career in medicine (MD, DO, PA, NP, or RN) should consider becoming a ... Review completed charts with the provider between patients or at the completion of shift * Update ...

BetterHelp

Licensed Psychologist- Remote

Albuquerque, NM · Remote

$650/wk

Work from the comfort of home (fully remote) * Flexible schedule - you set your own hours. * Free ... Also, we are unable to accept substance abuse counselors, school counselors, registered nurses ...

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Remote Utilization Review Rn information

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$40

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

As of Aug 3, 2026, the average hourly pay for remote utilization review rn in Albuquerque, NM is $40.98, 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 are the key skills and qualifications needed to thrive as a Remote Utilization Review RN, and why are they important?

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
What are the most commonly searched types of Utilization Review Rn jobs in Albuquerque, NM? The most popular types of Utilization Review Rn jobs in Albuquerque, NM are:
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Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Albuquerque, NM as of July 2026, with employment types broken down into 73% Full Time, 11% Part Time, and 16% Contract. Highlights an 43% Physical, 3% Hybrid, and 54% Remote job distribution, with an average salary of $80,272 per year, or $38.6 per hour.

Infusion Referral Nurse Sr - REMOTE

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

$74K - $118K/yr

Full-time

Posted 5 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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