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Utilization Review Manager Jobs in Rio Rancho, NM

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Utilization Review Manager information

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$36.7K

$85.6K

$157.6K

How much do utilization review manager jobs pay per year?

As of Sep 13, 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 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 key skills and qualifications needed to thrive as a utilization review manager?

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 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 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.

How much does a utilization review manager make?

A utilization review manager typically earns between $70,000 and $110,000 annually, depending on experience, location, and the size of the organization. They often require knowledge of healthcare policies, insurance processes, and may hold certifications such as URAC or CCM.

Is utilization review manager a stressful job?

Utilization review managers often work in a fast-paced healthcare environment, which can be stressful due to the need to meet strict deadlines, ensure accurate assessments, and handle complex cases. The role requires strong organizational skills and attention to detail, and some individuals may find the responsibility and workload challenging, especially during high-volume periods.

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:

What are popular job titles related to Utilization Review Manager jobs in Rio Rancho, NM?

For Utilization Review Manager jobs in Rio Rancho, NM, the most frequently searched job titles are:

What cities near Rio Rancho, NM are hiring for Utilization Review Manager jobs?

Cities near Rio Rancho, NM with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you

Drug Utilization Review (DUR) Pharmacist - Remote

Albuquerque, NM • On-site

Pharmacy Careers
See more jobs at Pharmacy Careersexternal

Other

Re-posted 3 days ago

Job description

Remote DUR Pharmacist – Safe & Cost-Effective Medication Use

Work From Home Analyze medication use patterns, apply clinical guidelines, and collaborate with providers — all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy clinical analysis and want to improve outcomes at scale. Key Responsibilities

  1. Conduct prospective, concurrent, and retrospective drug utilization reviews.
  2. Evaluate prescribing patterns against clinical guidelines and formulary criteria.
  3. Identify potential drug interactions, therapeutic duplications, and inappropriate therapy.
  4. Prepare recommendations for prescribers to optimize therapy and reduce risk.
  5. Document reviews and ensure compliance with state, federal, and health-plan requirements.
  6. Contribute to quality-improvement initiatives and pharmacy program development.

What You'll Bring

  • Education: PharmD or Bachelor of Pharmacy.
  • Licensure: Active U.S. pharmacist license.
  • Experience: Managed care, PBM, or health-plan preferred. Hospital and community pharmacists with strong clinical skills are encouraged to apply.
  • Skills: Analytical mindset, detail orientation, excellent written and verbal communication.

Why This Role?

  • Shape prescribing decisions that affect thousands of patients.
  • Build expertise in managed care and population-health pharmacy.
  • Many DUR roles offer hybrid or fully remote schedules.
  • Competitive salary, benefits, and career advancement.

About Us We are a confidential healthcare partner providing managed-care pharmacy services nationwide. Our DUR pharmacists ensure medications are used safely, appropriately, and cost-effectively. Apply Today Advance your career in managed care — apply now for our Remote Drug Utilization Review Pharmacist opening.

Apply