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

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Registered Nurse

Albuquerque, NM

... review and revision of plan of care; 3. Provision of Direct Patient Care: 3.1. Administers ... Utilization Management or Interdisciplinary Care Management Meeting to facilitate appropriate ...

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Travel RN Case Manager

Albuquerque, NM

Minimum of three years hospital based nursing practice with experience in utilization/case management. * BLS for Healthcare Providers required within 30 days of hire Work Experience: At least 2 years ...

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Utilization Review 1099 information

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$20

$39

$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
RN Case Manager - Inpatient Care Coordination

RN Case Manager - Inpatient Care Coordination

Presbyterian Healthcare Services

Albuquerque, NM • On-site

$34.68 - $52.95/hr

Other

Posted 29 days ago

Presbyterian Healthcare Services rating

7.3

Company rating: 7.3 out of 10

Based on 157 frontline employees who took The Breakroom Quiz

293rd of 870 rated healthcare providers

Job description

Location Address:
1100 Central Ave SEAlbuquerque, NM 87106-4930
Compensation Pay Range:
Minimum Offer $34.68Maximum Offer $52.95
Summary:
Make a difference. Presbyerian Hospital is hiring a RN Case Manager that will provide clinically-based case management to support the delivery of effective and efficient patient care. The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in order to meet patients needs, manage the length of stay, and promote efficient utilization of resources. In collaboration with the interdisciplinary team, the case manager supports the physician in facilitating patient care with the objective of enhancing the quality of patient outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers.
How you grow, learn and thrive matters here.
• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system
Type of Opportunity: PRNFTE: 0.00Job Exempt: NoWork Shift: Days (United States of America)
Responsibilities:
RN Case Manager - Inpatient
Type of Opportunity: Per Required Need
FTE: 0.001000
Exempt: No
Work Schedule: Days
Days 8 hour or 10 hour
Presbyterian Hospital - On-Site
Questions about this role? Schedule a call with a recruiter here.
  • Interviews and assesses each patient, family or other designated person(s) within 48 hours of admission in order to obtain financial, emotional, physical, social, functional and health care needs in order to define and recommend potential discharge plans, manage patient and family expectations, identify readmission risk and target interventions to reduce risk for readmission, and identify, adjust and manage barriers to discharge.
  • Applies approved clinical criteria to monitor appropriateness of admissions and continued stays to ensure a clear status determination. Refers cases and issues to Case Management Medical Director based on departmental standards.
  • Demonstrates skill in communicating with physicians the necessary documentation required to demonstrate medical necessity. Elevates to Supervisor and/or Medical Director all patients not meeting criteria after discussion with physician.
  • Demonstrates skill in educating patient, family and interdisciplinary team regarding post-acute care options, status determination, and other care coordination services.
  • Develops implements, coordinates, monitors and evaluates preliminary and final discharge plans with the interdisciplinary team, patient and family. Arranges and/or facilitates identified discharge needs and services of patients and ensures timely intervention to prevent delays in service and transition of care. Ensures all elements of the plan of care have been communicated to the patient/family and members of the healthcare team to assure continuity of care.
  • Participates and facilitates care progression in daily multidisciplinary rounds and addresses target length of stay with health care providers to achieve complete delivery of services within prescribed timeframe. Monitors length of stay and takes action to mitigate overutilization and elevates to medical director as needed.
  • Presents and actively participates in complex rounds, discharge planning huddles, process improvement teams, department specific initiatives and department meetings.
  • Identifies patients and families with complex psychosocial issues and refers them to the Social Worker as appropriate. Demonstrates skill and success in collaboration with Social Work partner.
  • Facilitates and leads patient/family and provider care conferences as needed.
  • Documents results of assessments, status assignment, and interventions and discharge planning in the medical record according to departmental policies and procedures.
  • Ensures safe care to patients adhering to policies, procedures, and standards within budgetary specifications, including time management, supply management, productivity and accuracy of practice.
  • Promotes individual and departmental professional growth and development by meeting requirements for and facilitating continuing education, skills competency. Supports departmental based goals which contribute to the success of the organization. Serves as a mentor, preceptor, mentor and resource to less experienced staff.

Qualifications:
RN IMM Case Management I
  • Associates Degree in nursing required.
  • *BSN within 5 years of hire date.
  • Current State of New Mexico Registered Nurse licensure required.
  • 2 years clinical nursing experience in relevant clinical practice area with utilization review or case management experience desirable.
  • National Case Management certification preferred

RN IMM Case Management II
  • Registered Nurse with Bachelors of Science in nursing (BSN) degree or Registered Nurse with Associates degree in nursing (ADN) plus five years utilization review or case management experience required.
  • BSN to be obtained within 5 years of hire date.
  • Current State of New Mexico Registered Nurse licensure required.
  • 2 years clinical nursing experience in relevant clinical practice area required.
  • National Case Management certification preferred

RN IMM Case Management III
  • Bachelors degree in nursing plus 5 years utilization review or case management experience required; or Masters degree in Nursing.
  • Current State of New Mexico Registered Nurse licensure required.
  • 2 years clinical nursing experience in relevant clinical practice area required.
  • National Case Management certification preferred.

RN IMM Case Management IV
  • Masters degree in nursing plus 5 years utilization review or case management experience required; or Bachelors degree in nursing plus 10 years utilization review or case management experience required.
  • Current State of New Mexico Registered Nurse licensure required.
  • 2 years clinical nursing experience in relevant clinical practice area required.
  • National Case Management certification preferred

We're all about well-being, starting with yours.
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.
Learn more about our employee benefits.
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.
Compensation Disclaimer
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

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About Presbyterian Healthcare Services

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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

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