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Utilization Review Nurse Jobs in Rio Rancho, NM (NOW HIRING)

Genesis Healcare

RN - Utilization Review

Albuquerque, NM · On-site

$2.4K/wk

Details Client Name Genesis - West Region - 103 Hospital Loop NE Albuquerque, NM Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 37450074 Job Title RN - Utilization ...

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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 Nurse JobsUtilization Review Nurse Jobs in Rio Rancho, NM

Utilization Review Nurse information

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How much do utilization review nurse jobs pay per hour?

As of Jul 12, 2026, the average hourly pay for utilization review nurse in Rio Rancho, NM is $40.01, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $45.96 per hour, depending on experience, location, and employer.

How to make $300,000 as a nurse?

To earn $300,000 as a Utilization Review Nurse, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying healthcare settings or take on additional responsibilities like case management or leadership roles. Working overtime, specializing in complex cases, or pursuing advanced degrees can also increase earning potential.

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

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What does a Utilization Review Nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What are some typical challenges Utilization Review Nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

What Does a Utilization Review Nurse Do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

What does a nurse do in a utilization review?

A utilization review nurse evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure that patient care aligns with insurance policies and clinical guidelines, often working with healthcare providers and insurance companies to approve or deny services. This role requires strong clinical knowledge, attention to detail, and familiarity with healthcare regulations and documentation tools.

How to get into utilization review as a nurse?

To become a utilization review nurse, candidates typically need a registered nurse (RN) license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can improve job prospects, and familiarity with medical records, insurance policies, and utilization review software is often required.

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

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

Is it hard to be a utilization review nurse?

Being a utilization review nurse involves reviewing medical records and determining appropriate care levels, which requires strong clinical knowledge, attention to detail, and good communication skills. The job can be demanding due to tight deadlines, the need for accuracy, and the responsibility of making critical decisions that impact patient care and insurance processes.
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Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Rio Rancho, NM as of July 2026, with employment types broken down into 2% As Needed, 63% Full Time, 20% Part Time, and 15% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $83,222 per year, or $40 per hour.

RN - Utilization Review

Genesis Healcare

Albuquerque, NM • On-site

$2.4K/wk

Other

Posted yesterday

Job description

Details
Client Name
Genesis - West Region - 103 Hospital Loop NE Albuquerque, NM
Job Type
Travel
Offering
Nursing
Profession
RN
Specialty
Utilization Review
Job ID
37450074
Job Title
RN - Utilization Review
Weekly Pay
$2488.0
Shift Details
Shift
Days 5x8
Scheduled Hours
40
Job Order Details
Start Date
07/27/2026
End Date
10/19/2026
Duration
12 Week(s)
Job Description
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
Address
103 Hospital Loop NE
City
Albuquerque
State
NM
Zip Code
87109

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