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Remote Utilization Review Rn Jobs in Rio Rancho, NM

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 ...

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 ...

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

Remote Utilization Review Rn information

See Rio Rancho, NM salary details

$20

$41

$67

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

As of Aug 22, 2026, the average hourly pay for remote utilization review rn in Rio Rancho, NM is $41.17, according to ZipRecruiter salary data. Most workers in this role earn between $32.55 and $47.31 per hour, depending on experience, location, and employer.

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 are the key skills and qualifications needed to thrive as a remote utilization review RN?

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 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 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 popular job titles related to Remote Utilization Review Rn jobs in Rio Rancho, NM?

For Remote Utilization Review Rn jobs in Rio Rancho, NM, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Rio Rancho, NM look for?

The top searched job categories for Remote Utilization Review Rn jobs in Rio Rancho, NM are:

What cities near Rio Rancho, NM are hiring for Remote Utilization Review Rn jobs?

Cities near Rio Rancho, 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 Rio Rancho, NM as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $85,640 per year, or $41.2 per hour.

Regulatory Analyst (Remote)

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

$66K - $106K/yr

Full-time

Posted 15 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 113 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
Regulatory Analyst (Remote)Job Description
The Regulatory Analyst is responsible for leading portions of regulatory assessment, external audits and accreditation processes within the Commercial, Medicare, Medicaid, and Health Insurance Marketplace for the assigned department. This position is responsible for primary point of contact for internal and external business partners regarding related regulatory activity and quality efforts involving utilization and/or medication therapy management, client delegation agreements and accreditation entities, SOP development and maintenance.
Responsibilities
  • Participate in portions of external audits as directed by the Centers for Medicare & Medicaid Services (CMS), Medicaid, NCQA, participate in commercial and Client driven external audits, annual reviews, and pre-delegation reviews and lead assigned department (i.e. Clinical Operations, PBM Operations) portions of ongoing Accreditation processes
  • Assist in Regulatory Review Committee Meetings, Healthcare Reform Meetings, Regulatory Oversight Meetings, CMS User Calls, and Government Programs Compliance Committee Meetings to monitor new regulations and provide necessary updates to these committees
  • Lead the Client, external auditor, and/or accreditation reviewer through Prime's business processes and provide the appropriate documentation and/or data files as they relate to accreditation standards or regulations
  • Maintain regulatory and accreditation gap status reporting to keep all constituencies informed; track, manage, and report on work stream status against plan
  • Lead all efforts for response to inquiries related to the assigned department, which may include pulling pertinent case files/samples, validating regulatory requirements, and review and validation of processes against requirements
  • Take lead on change management related to regulatory requirements
  • Other duties as assigned

Minimum Qualifications
  • Bachelor's degree in business, finance, health services or related area of study, or equivalent combination of education and/or relevant work experience
  • 3 years of PBM, healthcare, and/or compliance work experience
  • Must be eligible to work in the United States without need for work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
  • Strong verbal and written communication skills
  • Demonstrated critical thinking and analysis skills with the ability to interpret regulations into operational requirements
  • Strong attention to detail and commitment to meeting established timeliness

Preferred Qualifications
  • Demonstrated knowledge of CMS regulations and Health Care Reform and extensive knowledge of clinical review and/or medication therapy management processes/procedures
  • Proficient in standard software (Word, Visio, and Excel)

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 $66,000.00 - $106,000.00 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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