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Remote Utilization Review Rn Jobs in Albuquerque, NM

Varsity Tutors

NCLEX-PN Tutor

Albuquerque, NM · Remote

$18 - $40/hr

... RN scope questions, pharmacology calculations, and managing anxiety with the adaptive testing format. Adapts instruction using NCLEX-PN specific practice question banks, content review focused on ...

Magellan Health, Inc.

Care Coordinator - NM

Albuquerque, NM · On-site +1

$17.50 - $23.75/hr

This position is remote within New Mexico. Coordinates care of individual clients with application ... RN - Registered Nurse, State and/or Compact State Licensure - Care MgmtCare Mgmt Salary Range ...

Varsity Tutors

NCLEX Tutor

Albuquerque, NM · Remote

$25 - $40/hr

Adapts instruction using NCLEX review resources, practice question banks, and clinical scenario analysis to support nursing graduates preparing for first-time licensure as registered nurses or ...

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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Remote Utilization Review Rn information

See Albuquerque, NM salary details

$19

$38

$62

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

As of Jul 20, 2026, the average hourly pay for remote utilization review rn in Albuquerque, NM is $38.59, according to ZipRecruiter salary data. Most workers in this role earn between $30.48 and $44.33 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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What job categories do people searching Remote Utilization Review Rn jobs in Albuquerque, NM look for? The top searched job categories for Remote Utilization Review Rn jobs in Albuquerque, NM are:
What cities near Albuquerque, NM are hiring for Remote Utilization Review Rn jobs? Cities near Albuquerque, NM with the most Remote Utilization Review Rn job openings:
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 82% Full Time, 12% Part Time, 2% Temporary, and 4% Contract. Highlights an 39% Physical, 2% Hybrid, and 59% Remote job distribution, with an average salary of $80,272 per year, or $38.6 per hour.
CISC Care Coordinator, Licensed

CISC Care Coordinator, Licensed

Magellan Health, Inc.

Albuquerque, NM • On-site, Remote

$17.25 - $23.50/hr

Full-time

Medical, Life

Re-posted 3 days ago

Job description

Independently coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes. Duties performed are either during face-to-face home visits or facility based depending on the assignment. Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction. Assists with orientation and mentoring of new team members as appropriate. May act as a team lead for non-licensed care coordinators.
  • Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources.
  • Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
  • Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately (e.g., during transition to home care, back up plans, community based services).
  • Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes.
  • Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
  • Acts as an advocate for members' care needs by identifying and addressing gaps in care.
  • Performs ongoing monitoring of the plan of care to evaluate effectiveness.
  • Measures the effectiveness of interventions as identified in the members care plan.
  • Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes.
  • Collects clinical path variance data that indicates potential areas for improvement of case and services provided.
  • Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary.
  • Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care.
  • Facilitates a team approach to the coordination and cost effective delivery to quality care and services.
  • Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum.
  • Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases.
  • Provides assistance to members with questions and concerns regarding care, providers or delivery system.
  • Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources.
  • Generates reports in accordance with care coordination goals.

Other Job Requirements
Responsibilities
Associate's Degree in Nursing required for RNs, or Master's Degree in Social Work or Healthcare-related field, with an independent license, for Social Workers.
Licensed in State that Services are performed and meets Magellan Credentialing criteria.
2+ years' post-licensure clinical experience.
Experience in utilization management, quality assurance, home or facility care, community health, long term care or occupational health required.
Experience in analyzing trends based on decision support systems.
Business management skills to include, but not limited to, cost/benefit analysis, negotiation, and cost containment.
Knowledge of referral coordination to community and private/public resources.
Requires detailed knowledge of cost-effective coordination of care in terms of what and how work is to be done as well as why it is done, this level include interpretation of data.
Ability to make decisions that require significant analysis and investigation with solutions requiring significant original thinking.
Ability to determine appropriate courses of action in more complex situations that may not be addressed by existing policies or protocols.
Decisions include such matters as changing in staffing levels, order in which work is done, and application of established procedures.
Ability to establish strong working relationships with clinicians, hospital officials and service agency contacts. Computer literacy desired.
Ability to maintain complete and accurate enrollee records. Effective verbal and written communication skills.
General Job Information
Title
CISC Care Coordinator, Licensed
Grade
24
Work Experience - Required
Clinical
Work Experience - Preferred
Education - Required
Associate - Nursing, Master's - Social Work
Education - Preferred
License and Certifications - Required
DL - Driver License, Valid In State - Other, LISW - Licensed Independent Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LMSW - Licensed Master Social Worker - Care Mgmt, LPCC - Licensed Professional Clinical Counselor - Care Mgmt, LPN - Licensed Practical Nurse - Care Mgmt, PSY - Psychologist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Salary Range
Salary Minimum:
$58,440
Salary Maximum:
$93,500
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

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