ZipRecruiter

Log In

2

Remote Utilization Review Jobs in New Mexico (NOW HIRING)

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 ... Such requests will be subject to review and approval by the Company, and exemptions will be granted ...

IDEX

Key Account Manager

Albuquerque, NM · On-site +1

Please note this role can be US Remote. Role Overview: Based in the US the Key Account Manager is ... Conduct regular face to face meetings with key customer stakeholders to review new business ...

JDA

Sr. Director, Finance -IT

Roswell, NM · On-site +1

US Remote Dallas and Scottsdale preferred Overview: The Senior Director, Finance IT is a senior ... Conduct regular license and entitlement reviews across all Finance platforms to ensure the ...

All JobsUtilization Review JobsRemote Utilization Review JobsRemote Utilization Review Jobs in New Mexico

Remote Utilization Review information

See New Mexico salary details

$20

$40

$66

How much do remote utilization review jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for remote utilization review in New Mexico is $40.97, 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 a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What are the key skills and qualifications needed to thrive in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What are the most commonly searched types of Utilization Review jobs in New Mexico?

The most popular types of Utilization Review jobs in New Mexico are:

What are popular job titles related to Remote Utilization Review jobs in New Mexico?

For Remote Utilization Review jobs in New Mexico, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review jobs in New Mexico look for?

The top searched job categories for Remote Utilization Review jobs in New Mexico are:

What cities in New Mexico are hiring for Remote Utilization Review jobs?

Cities in New Mexico with the most Remote Utilization Review job openings:

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in New Mexico as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,227 per year, or $41 per hour.

LTC Utilization Management Reviewer

Presbyterian Healthcare Services

Albuquerque, NM • On-site, Remote

$65K - $111K/yr

Full-time

Medical, Dental, Vision, Life

Posted 3 days ago

New

Presbyterian Healthcare Services rating

7.2

Company rating: 7.2 out of 10

Based on 164 frontline employees who took The Breakroom Quiz

345th of 891 rated healthcare providers

Job description

Location Address:
9521 San Mateo NEAlbuquerque, NM 87113-2237
Compensation Pay Range:
Minimum Offer $65,520.00Maximum Offer $111,612.80Now Hiring: LTC Utilization Management Reviewer
Summary:
Build your Career. Make a Difference. Presbyterian is hiring a skilled LTC Utilization Management Reviewer to join our team.Type of Opportunity: Full timeJob Exempt: YesJob is based: Reverend Hugh Cooper Administrative CenterWork Shift: Days (United States of America)
Responsibilities:
Now hiring a Utilization Management Reviewer-LTC
Responsible for conducting Nursing (NF) Facility Level of Care (LOC) determinations according to state regulations and criteria. Performs utilization review activities to ensure that services rendered to members meet Long Term Care Supports and Services (LTSS) criteria and services are delivered in the appropriate setting. Utilizes LTSS skills and established criteria to review, coordinate, document and approve all aspects of the utilization/benefit management program, including but not limited to community benefit care plans and self-directed community benefit care plans and budgets. Validates and interprets documentation using approved LTSS criteria. Consults with PHP medical directors and refers for medical director decisions on cases not meeting LTSS criteria, NF LOC denials and care plans that result in a reduction in service or benefit denial. Refers cases for Quality Management review and Special Investigative Review as indicated for quality of care issues and possible abuse/fraud
Some key responsibilities include:
  • NF LOC evaluations and determinations,
  • Responsible for the review of all required medical documentation against HSD criteria and to provide an objective evaluation and determination of NF LOC medical eligibility (approvals and denials).
  • Documents recommendations and NF LOC determinations (approvals, request for more information and denials in PHPs case management system, including appropriate documentation of authorization and NF LOC begin and end date eligibility spans according to established HSD policies. Refers all NF LOC denials to the health plans medical director for review.
  • Prepares files and participates in state fair hearing procedures.
  • Reviews agency-based community benefit care plans for appropriateness according to established LTC benefit UM criteria and guidelines and according to required timelines. Approves (full or partial) or denies care plan according to criteria and available documentation
  • Documents Agency-based community benefit care plan approvals, partial approvals and denials in PHPs case management system according to policies and procedures and job-aids.
  • Reviews self-directed community benefit care plans and budgets for appropriateness according to established LTC benefit UM criteria and guidelines and according to required timelines. Approves (full or partial) or denies care plan according to criteria and available documentation
  • Reviews care plans to assure the overall cost of the community benefit care plan does not exceed the overall cost of care in a nursing home based on the benchmark provided by HSD.
  • Documents self-directed community benefit care plan and budget approvals, partial approvals and denials in PHPs case management system and the Fiscal Management agencys information system according to policies and procedures and job-aids.

Qualifications:
  • Active Nursing license in NM or compact license (RN or LPN) with a minimum of one year of relevant experience
  • Medical Social Worker with a minimum of one year of relevant experience; or
  • Physical, Occupational, or Rehab Therapists with a minimum of one year of relevant experience.
  • Prefer 1 year of experience in MCO, health plan insurance environment , with expertise performing utilization management or experience working in long term care services
  • Knowledge of all state and federal regulations concerning the use, disclosure, and confidentiality of all patient records.
  • Analytical skills as applicable to interpret provider communication and medical records.
  • Attention to detail and organizational skills.
  • Ability to articulate orally and in writing an understanding of complex issues and detailed action plans, while best
  • representing the organization professionally.
  • Ability to work cooperatively with other employees and departments.
  • Efficient and comfortable with computer electronic data entry and documentation
  • Ability to succinctly document using correct spelling and grammar.
  • Able to summarize from medical clinical notes, progress notes, needs assessments, functional assessments, progress notes, history and physicals , care plans and other state required documentation.
  • Able to meet timelines and deadlines associated with work load.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

What Presbyterian Healthcare Services employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Presbyterian Healthcare Services logo

About Presbyterian Healthcare Services

Sourced by ZipRecruiter

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Albuquerque, NM, US

Year founded

1908

Social media

FacebookTwitter

View All Presbyterian Healthcare Services Jobs

Apply