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Utilization Review Manager Jobs in Rio Rancho, NM

GQR

RN - Case Manager

Albuquerque, NM · On-site

$1.6K - $1.7K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Albuquerque, New Mexico Start Date: July 20, 2026 Profession: Registered Nurse (RN) Facility: Rehabilitation ...

Prime Staffing

Travel RN Case Manager

Albuquerque, NM · On-site

Travel Work Settings Acute Hospital Long Term Acute Care/Rehab/Skilled Nursing Case Management/Utilization Review Admission Criteria Care coordination Discharge Planning Utilize InterQual Criteria ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Rio Rancho, NM

Utilization Review Manager information

See Rio Rancho, NM salary details

$36.7K

$85.6K

$157.6K

How much do utilization review manager jobs pay per year?

As of Jul 12, 2026, the average yearly pay for utilization review manager in Rio Rancho, NM is $85,606.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,000.00 and $103,000.00 per year, depending on experience, location, and employer.

What are some common challenges faced by Utilization Review Managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

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

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What does a Utilization Review Manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.
What are the most commonly searched types of Utilization Review jobs in Rio Rancho, NM? The most popular types of Utilization Review jobs in Rio Rancho, NM are:
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Utilization Review Manager jobs near you

Drug Utilization Review Pharmacist

Pharmacy Careers

Albuquerque, NM • On-site

Other

Medical

Re-posted 29 days ago

Job description

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications
A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support quality prescribing and improve patient outcomes. This role is ideal for pharmacists who enjoy analyzing medication use, applying clinical guidelines, and collaborating with providers to promote safe, cost-effective care.
Key Responsibilities
  • Conduct prospective, concurrent, and retrospective drug utilization reviews.
  • Evaluate prescribing patterns against clinical guidelines and formulary criteria.
  • Identify potential drug interactions, duplications, and inappropriate therapy.
  • Prepare recommendations for prescribers to optimize therapy and reduce risk.
  • Document reviews and ensure compliance with state, federal, and health plan requirements.
  • Contribute to quality improvement initiatives and pharmacy program development.
What You'll Bring
  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Managed care, PBM, or health plan experience preferred - but hospital and retail pharmacists with strong clinical skills are encouraged to apply.
  • Skills: Analytical mindset, detail-oriented, and excellent written and verbal communication.
Why This Role?
  • Impact: Shape prescribing decisions that affect thousands of patients.
  • Growth: Build expertise in managed care and population health pharmacy.
  • Flexibility: Many DUR roles offer hybrid or fully remote schedules.
  • Rewards: Competitive salary, benefits, and career advancement opportunities.

About Us
We are a confidential healthcare partner providing managed care pharmacy services nationwide. Our DUR pharmacists play a key role in ensuring that medications are used safely, appropriately, and cost-effectively across diverse patient populations.
Apply Today
Advance your career in managed care pharmacy - apply now for our Drug Utilization Review Pharmacist opening and help lead the way in improving medication safety and outcomes.

Apply