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Utilization Review Manager Jobs in Rio Rancho, NM

Encompass Health

Case Manager

Albuquerque, NM · On-site

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Phsorg

Clinic Manager - Oncology

Albuquerque, NM

... utilization of space, time, supplies, and equipment. In collaboration with the PMG nursing ... Coordinates required review competencies of appropriate licenses and non-licensed clinical and ...

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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 Sep 14, 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

Traveling Home Care Field Supervisor for Veterans

Albuquerque, NM

Live Well Home Care
See more jobs at Live Well Home Careexternal

$50K/yr

Full-time

Posted 16 days ago

Job description

Field Supervisor is responsible for conducting assessments to new clients and supervisory for existing clients. This includes detailing their scope of service, performing supervisory visits and assessments, providing detailed reports of all client correspondence.

Duties/Responsibilities:

  • Calls new clients to set up home visits.

  • Opens cases with clients, including confirming proper documentation and information is obtained.

  • Assess clients’ situation and environment.

  • Reviews and assesses the quality of care performed by the caregivers.

  • Conducts follow-up visits as needed or requested.

  • Documents all visits and communication with clients and caregivers.

  • Conducts client surveys every 3-4 months for home visits.

  • Distributes necessary supplies to caregivers/clients as needed.

  • Responsible for scheduling qualified PCA’s to work all authorized hours according to each client’s Service Plan.

  • Provide verbal and/or face to face attendant orientations

  • Complete daily monitoring of all attendant timekeeping through EVV, including monitoring for missed or late shifts, ensuring all hours are worked, and tracking for mileage, overtime, and travel time.

  • Maintaining an authorization / utilization percentage of 95% or greater

  • Maintain compliance for all client charts by filing all forms timely and maintaining stacking order

  • Maintain compliance for all personnel files by filing all forms timely and maintaining stacking order

  • Ensure all communication with clients is documented in the Electronical Medical Record and filed accordingly in the client file

  • Maintain regular communication with clients and attendants to ensure satisfaction with service delivery

  • Coordinate with Branch Manager to provide documentation for client and employee incidents and complaints

  • Assist with Client Admissions and Supervisory Visits when requested by Branch Manager

  • Attend daily and weekly meetings, including stand up/stand down, authorization/utilization review, and HR and Compliance Updates with Branch Manager

  • Assist with recruiting, hiring, and orienting new attendants

  • Provide new attendants with access and support for the online training platform

  • Provide ongoing training and coaching to attendants when needed

  • Complete timely annual performance evaluations for all attendants

  • Completes other assignments as requested and assigned.

Required Skills/Abilities:

  • Excellent verbal and written communication skills.

  • Excellent interpersonal and customer service skills.

  • Excellent organizational skills and attention to detail.

  • Excellent time management skills with a proven ability to meet deadlines.

  • Strong analytical and problem-solving skills.

  • Ability to prioritize tasks.

  • Ability to function well in a high-paced and at times stressful environment.

  • Proficient with Microsoft Office Suite or related software.

Physical Requirements:

Prolonged periods of sitting at a desk and working on a computer.

Must be able to lift up to 15 pounds at times.