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Utilization Review Manager Jobs in Rio Rancho, NM

Prime Staffing

Travel Case Manager

Rio Rancho, NM · On-site

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

New

UNMHSCHS

RN CASE MANAGER

Rio Rancho, NM · On-site

Manage the course of treatment of patients, coordinating care with physicians, nurses and other ... utilization review, maintaining interdependent follow-up as necessary * TREATMENT CONFERENCE ...

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Utilization Review Manager information

See Rio Rancho, NM salary details

$35.2K

$82.1K

$151.1K

How much do utilization review manager jobs pay per year?

As of Aug 22, 2026, the average yearly pay for utilization review manager in Rio Rancho, NM is $82,083.00, according to ZipRecruiter salary data. Most workers in this role earn between $53,700.00 and $98,800.00 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

Utilization Review

Genesis - West Region - 2216 Lester Drive NE Albuquerque, NM

Albuquerque, NM • On-site

Other

Posted 19 days ago

Job description

Travel Nurse Manager

Excel is seeking highly skilled healthcare professionals for travel assignments across the United States. As a Travel Healthcare Professional, you will have the opportunity to work in diverse healthcare settings, providing essential medical care while exploring new locations and cultures.

Key Responsibilities:

  • Provide direct patient care in accordance with healthcare facility policies and procedures.
  • Collaborate with interdisciplinary teams to ensure comprehensive patient care.
  • Maintain accurate patient medical records and documentation.
  • Adhere to infection control standards and other regulatory requirements.
  • Educate patients and their families on healthcare plans and treatments.

Qualifications:

  • Active state licensure in [specify relevant states] (e.g., RN, LPN, PT, OT).
  • Minimum [number] years of experience in [specialty].
  • BLS/CPR certification (ACLS, PALS, or others as required by specialty).
  • Excellent communication and interpersonal skills.
  • Ability to adapt to different environments and work independently.

Why Choose Excel Medical Staffing:

  • Trusted partner with a proven track record in healthcare staffing.
  • Competitive compensation package including hourly wages and stipends.
  • Access to a wide range of healthcare facilities and specialties.
  • Personalized support throughout your assignment.
  • Opportunity to enhance your skills and build a diverse professional portfolio.

Client Details:

  • City: Albuquerque
  • State: NM

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