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Remote Utilization Review Rn Jobs in Albuquerque, NM

DataAnnotation

Registered Nurse

Rio Rancho, NM · Remote

$40 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

DataAnnotation

Registered Nurse

Albuquerque, NM · Remote

$40 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

NOMAD

Travel Nurse - Step-Down $2,392/wk

Albuquerque, NM · Remote

$2K/wk

Nomad offers Registered Nurses a hassle-free experience, industry-leading pay rates, full benefits ... Additional Confirmations Telemetry - remote monitoring experience is required. * Travel Contract ...

DataAnnotation

RN

Rio Rancho, NM · Remote

$40 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

DataAnnotation

RN

Albuquerque, NM · Remote

$40 - $60/hr

Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...

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 ...

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Remote Utilization Review Rn information

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

As of Jun 12, 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 is the meaning of the word remote?

In the context of a Remote Utilization Review RN job, 'remote' refers to working outside of a traditional office setting, often from home or another location of the employee's choice. This setup typically involves using digital tools and communication platforms to perform job duties without being physically present in an office environment.

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 meaning of remote in one word?

In the context of a Remote Utilization Review RN role, 'remote' means working from a location outside of a traditional office, typically from home, using digital communication tools. It emphasizes flexibility and virtual access to work systems without physical presence at a healthcare facility.

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.

How to make 2000 a week working from home?

A Remote Utilization Review RN can potentially earn $2,000 weekly by working full-time hours, often 40 hours per week, and gaining experience or certifications that allow for higher billing rates. Increasing income may involve taking on additional cases, specializing in high-demand areas, or working for agencies that offer competitive pay for remote utilization review roles.

What is remote job?

A remote Utilization Review RN job is a healthcare position where the nurse reviews patient cases and insurance claims from a location outside of a traditional office, often working from home. It requires strong communication skills, knowledge of medical documentation, and familiarity with electronic health record systems, with flexible schedules common in remote roles.

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
Physician Clinical Reviewer -Endocrinology- REMOTE

Physician Clinical Reviewer -Endocrinology- REMOTE

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

$90.87 - $154.33/hr

Part-time

Posted yesterday

Prime Therapeutics rating

7.7

Company rating: 7.7 out of 10

Based on 44 frontline employees who took The Breakroom Quiz

18th of 99 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
Physician Clinical Reviewer -Endocrinology- REMOTEJob Description
The Physician Clinical Reviewer is a key member of the utilization management team and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. This role routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required.
Responsibilities
Physician Clinical Reviewer - Job Description Responsibilities
  • Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer.
  • Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax.
  • Provides clinical rationale for standard and expedited appeals.
  • Provides assistance and acts as a resource to Initial Clinical Reviewers as needed to discuss cases and problems.
  • Utilizes medical/clinical review guidelines and parameters to assure consistency in the physician review process so as to reflect appropriate utilization and compliance with Prime's policies/procedures, as well as URAC and NCQA guidelines.
  • Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner.
  • Participates in on-going inter-rater reliability training and testing
  • Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.
  • On a requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions.
  • On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the VP, Medical Director
  • Other duties as assigned.

Minimum Qualifications
  • Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO) or Bachelor of Medicine, Bachelor of Surgery (MBBS) international degree with successful completion of United States based internship and residency (and successful completion of United States based fellowship for subspecialists) required
  • Current, unrestricted license to practice medicine in one or more states of the United States
  • Board Certified by one of the following: American Board of Medical Specialties (ABMS), American Board of Osteopathic Specialties (ABOS), American Board of Internal Medicine or American Board of Osteopathic Internal Medicine (ABIM/ABOIM)
  • 1 year of work experience in clinical review

Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Additional Qualifications
  • Familiarity with the principles and procedures of utilization management as practiced in managed care organizations

Preferred Qualifications
  • Medicare Part D experience.
  • Experience with cost benefit analysis, quality assurance and the continuous quality improvement process

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 $90.87 - $154.33 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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