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Utilization Review Case Manager Jobs in New Mexico

MTK Healthcare

RN-Case Manager

Portales, NM · On-site

$59 - $62/hr

MTK Healthcare Inc. is Hiring RN Case Manager - Utilization Review & Swing Bed | Portales, NM | Monday-Friday (8:00 AM-4:30 PM), Day Shift Position Details * Position: RN Case Manager - Utilization ...

MTK HealthCare

RN-Case Manager

Portales, NM · On-site

$59 - $62/hr

MTK Healthcare Inc. is Hiring RN Case Manager - Utilization Review & Swing Bed | Portales, NM | Monday-Friday (8:00 AM-4:30 PM), Day Shift Position Details * Position: RN Case Manager - Utilization ...

Hired by Matrix

RN Utilization Review

Portales, NM · On-site

Routine case management, discharge planning, swing bed coordinator and utilization review duties. * Evaluating and screening potential admissions to the facilities swing bed program * knowledgeable ...

Presbyterian Healthcare Services

$36.41 - $62/hr

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 ...

Phsorg

$36.41 - $62/hr

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 ...

Presbyterian Healthcare Services

$36.41 - $62/hr

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 ...

Phsorg

$36.41 - $62/hr

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 ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in New Mexico

Utilization Review Case Manager information

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$35

$58

How much do utilization review case manager jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for utilization review case manager in New Mexico is $35.36, according to ZipRecruiter salary data. Most workers in this role earn between $28.65 and $37.26 per hour, depending on experience, location, and employer.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

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

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

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

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

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

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

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in New Mexico as of August 2026, with employment types broken down into 98% Full Time, and 2% Part Time. Highlights an 96% In-person, 2% Hybrid, and 2% Remote job distribution, with an average salary of $73,544 per year, or $35.4 per hour.

RN-Case Manager

MTK Healthcare

Portales, NM • On-site

$59 - $62/hr

Contractor

Re-posted 22 days ago

Job description

MTK Healthcare Inc. is Hiring

RN Case Manager – Utilization Review & Swing Bed | Portales, NM | Monday–Friday (8:00 AM–4:30 PM), Day Shift

Position Details

  • Position: RN Case Manager – Utilization Review & Swing Bed

  • Location: Portales, NM 88130

  • Contract Length: 13 Weeks

  • Shift: Monday–Friday, 8:00 AM–4:30 PM (Day Shift)

  • Pay Rate: $59–$62/hour

  • Guaranteed Hours: 40 Hours per Week

  • No On-Call Required

Requirements

  • Active RN License

  • Minimum 5 years of Case Management experience

  • Experience in Utilization Review and Discharge Planning

  • Knowledge of Medicare, Medicaid, HMO, Swing Bed, and Private Insurance coverage

  • Experience with InterQual criteria and MDS documentation
    Key Responsibilities

  • Perform utilization review, case management, discharge planning, and swing bed coordination.

  • Evaluate and screen patients for swing bed admissions.

  • Coordinate discharge planning with patients, families, physicians, and the interdisciplinary care team.

  • Obtain referrals and prior authorizations for post-acute services.

  • Complete utilization reviews and ensure appropriate level of care documentation.

  • Run InterQual reviews for inpatient and observation admissions.

  • Collaborate with healthcare providers to ensure timely, safe, and effective patient transitions.