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Utilization Review 1099 Jobs in Rio Rancho, NM (NOW HIRING)

w3r Consulting

Utilization Review Nurse

Albuquerque, NM · On-site

Essential Duties and Responsibilities: • Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services ...

UnitiMed

RN Case Manager

Albuquerque, NM · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

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Utilization Review 1099 information

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$20

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$64

How much do utilization review 1099 jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for utilization review 1099 in Rio Rancho, NM is $39.77, according to ZipRecruiter salary data. Most workers in this role earn between $31.44 and $45.67 per hour, depending on experience, location, and employer.

What are some typical challenges faced by Utilization Review professionals working as 1099 contractors, and how can they be managed?

Utilization Review professionals working as 1099 contractors often face challenges such as fluctuating caseloads, varying client requirements, and the need to stay current with changing regulations independently. Unlike full-time employees, contractors must also manage their own schedules, billing, and sometimes provide their own resources and training. To succeed, it's important to establish clear communication with clients, maintain up-to-date credentials, and leverage professional networks or continuing education resources to stay informed about industry changes.

What are the key skills and qualifications needed to thrive as a Utilization Review 1099, and why are they important?

To thrive as a Utilization Review 1099 professional, you need a strong clinical background (often as a registered nurse or similar), experience with medical necessity criteria, and familiarity with insurance guidelines. Proficiency with utilization management software, electronic health records (EHRs), and knowledge of regulatory requirements are typically required, along with URAC or CCM certification being advantageous. Excellent analytical thinking, attention to detail, and effective communication skills are essential for collaborating with healthcare providers and payers. These skills ensure accurate, efficient review of patient care for coverage decisions, compliance, and cost-effective healthcare delivery.

What is a Utilization Review 1099 position?

A Utilization Review 1099 position refers to a healthcare professional, often a nurse or therapist, who works as an independent contractor (not a direct employee) to review medical cases for necessity and efficiency. The '1099' designation means they receive a Form 1099 for tax purposes and are responsible for their own taxes. Utilization Review specialists evaluate patient records to ensure treatments are appropriate and meet insurance or regulatory guidelines. These roles are often remote and offer flexible hours, but do not provide traditional employee benefits.

What is the difference between Utilization Review 1099 vs Utilization Review Nurse?

AspectUtilization Review 1099Utilization Review Nurse
CredentialsVaries; often self-employed or independent contractorsRegistered Nurse (RN) license required
Work EnvironmentRemote or freelance; contract basisHealthcare facilities, insurance companies, or clinics
Employer/Industry UsageFreelance or independent consulting in healthcareHospitals, insurance providers, healthcare organizations
Work FocusReviewing medical necessity for insurance claimsAssessing patient records, making clinical decisions

Utilization Review 1099 typically refers to independent contractors reviewing insurance claims, often working remotely. Utilization Review Nurse is a licensed RN performing clinical assessments within healthcare settings. While both roles involve utilization review, the 1099 role emphasizes independent contracting, whereas the nurse role requires clinical credentials and direct patient or clinical record involvement.

What are popular job titles related to Utilization Review 1099 jobs in Rio Rancho, NM? For Utilization Review 1099 jobs in Rio Rancho, NM, the most frequently searched job titles are:
What job categories do people searching Utilization Review 1099 jobs in Rio Rancho, NM look for? The top searched job categories for Utilization Review 1099 jobs in Rio Rancho, NM are:
What cities near Rio Rancho, NM are hiring for Utilization Review 1099 jobs? Cities near Rio Rancho, NM with the most Utilization Review 1099 job openings:
Utilization Review 1099 jobs near you
Utilization Review Nurse

Utilization Review Nurse

w3r Consulting

Albuquerque, NM • On-site

Full-time

Posted 25 days ago

Job description

Description:
Registered Nurse responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: drugs and biologics, inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts.
Essential Duties and Responsibilities:
• Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies and compliance guidelines.
• Uses an established set of criteria to evaluates and authorize the medical necessity of services.
• Provide notification of decisions in accordance with compliance guidelines.
• Coordinate with Medical Directors when services do not meet criteria or require additional review.
• Participation in staff meetings, regular trainings and other collaborative meetings as appropriate.
• Works with management team to achieve operational objectives and financial goals.
• Supports teams across UM Department as needed.
• Active participation and completion of all required trainings.
• Maintain Required Licensures.
• Adherence to regulatory and departmental timeframes for review of requests
• Meet/exceed department Turn Around time, daily established productivity goals, and service levels
• Proficient knowledge of policies and procedures, Medicare, HIPPA and NCQA standards;
• Professional demeanor and the ability to work effectively within a team or independently;
• Flexible with the ability to shift priorities when required
• Other duties as required
Qualifications:
• Current unrestricted RN license. Multi-State License Preferred
• Bachelors degree in nursing or health-care related field preferred
• Minimum of 2 years experience in a regulated environment preferred
• Minimum of 2-3 years clinical experience
• Strong customer orientation
• Strong organizational, planning, and communication skills
• Working knowledge of insurance industry, medical coding (CPT/HCPCS/ICD-10), and overall claims process a plus
• Knowledge of National Coverage Determinations, Local Coverage Determinations and MCG criteria are a plus.
• Excellent time management skills
Knowledge, Skills, Abilities Required:
• Excellent interpersonal and communications skills with nursing staff, physicians, nurse practitioners and other health workers involved in the care of a member
• Ability to meet deadlines and manage multiple priorities, and effectively adapt and respond to complex, fast-paced, rapidly growing, and results-oriented environments
• Able to work in a dynamic, fast-paced team environment and to promote team concepts
• Excellent typing skills.
• Substantial knowledge of Microsoft Office including SharePoint, Outlook, PowerPoint, Excel and Word.

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