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Utilization Management Case Manager Rn Jobs in New Mexico

UNM HOSPITALS

RN CASE MANAGER

Albuquerque, NM · On-site

RN CASE MANAGER - CARE MANAGEMENT DEPARTMENT - University of New Mexico Hospital - Albuquerque ... Utilization Management * *SRMC Care Management * *Full Time * *Part Time * Receive 17% Weekday ...

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Utilization Management Case Manager Rn information

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

AspectUtilization Management Case Manager RnUtilization Review Nurse
CredentialsRN license, certification in case management (e.g., CCM)RN license, often with certification in utilization review
Work EnvironmentInsurance companies, healthcare facilities, case management teamsHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing cases, ensuring appropriate utilizationReviewing medical necessity, approving or denying services
Common TasksAssessing patient needs, developing care plans, liaising with providersEvaluating medical records, making utilization decisions, ensuring compliance

The main difference is that the Utilization Management Case Manager Rn focuses on coordinating patient care and managing cases, while the Utilization Review Nurse primarily reviews medical records to approve or deny services. Both roles require RN licensure and related certifications, but their daily responsibilities and work environments differ slightly.

Are utilization management case managers in demand?

Utilization management case managers are in demand due to the growing need for healthcare cost control and efficient patient care coordination. Employers in healthcare organizations, insurance companies, and managed care plans seek professionals with strong clinical knowledge, certification, and experience in utilization review processes. The role offers stable employment opportunities as healthcare systems focus on cost-effective treatment management.

What cities in New Mexico are hiring for Utilization Management Case Manager Rn jobs?

Cities in New Mexico with the most Utilization Management Case Manager Rn job openings:

Infographic showing various Utilization Management Case Manager Rn job openings in New Mexico as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution.

Clinical Case Manager - RN

Albuquerque, NM

Career Land Center, LLC
Recruiting and Staffing Services • 1 - 10 employees
Learn more about Career Land Center, LLCexternal

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

Job description

A Healthcare Facility is seeking a Clinical Access Case Manager (RN) to support hospital-wide utilization management and care coordination. 

Position Overview

This role focuses on clinical access and utilization review across all inpatient populations. The Case Manager applies established criteria to support appropriate admission status, level-of-care decisions, and safe transitions throughout the patient stay. 

Work is completed in collaboration with physicians, nurses, and interdisciplinary teams throughout the facility, using InterQual criteria and Cerner-based systems to guide decision-making and documentation.

Key Responsibilities

• Perform utilization review and clinical access evaluations for inpatient admissions
• Apply InterQual criteria to support level-of-care determinations
• Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate patient placement
• Support timely and appropriate care transitions across the continuum
• Identify opportunities to improve utilization, throughput, and resource management
• Document clinical reviews and care decisions accurately within Cerner systems
• Communicate findings and recommendations clearly to clinical teams
• Support compliance with regulatory and payer requirements related to utilization management
• Assist with coordination of patient flow across hospital departments

Qualifications

• Associate degree in Nursing or higher required
• Minimum of 2 years of acute care experience required
• Experience with InterQual and utilization review/management required
• Experience with CCM, ACM, or Milliman criteria preferred
• Basic Life Support (BLS) required upon submission
• Active New Mexico or compact RN license required prior to start (open to candidates without current licensure at time of application)
• Strong understanding of acute care workflows and hospital-based care coordination

Benefits

• Comprehensive medical, dental, and vision coverage
• Paid time off and holiday benefits
• Retirement savings program
• Continuing education and certification support
• Opportunity to work in a hospital-wide utilization management role within a multi-service acute care facility
• Collaborative interdisciplinary environment focused on improving patient flow and care efficiency
• Sign-on incentive available