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

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Utilization Review Nurse information

See Rio Rancho, NM salary details

$20

$40

$65

How much do utilization review nurse jobs pay per hour?

As of Aug 1, 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.
More about Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Rio Rancho, NM? The most popular types of Utilization Review Nurse jobs in Rio Rancho, NM are:
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What job categories do people searching Utilization Review Nurse jobs in Rio Rancho, NM look for? The top searched job categories for Utilization Review Nurse jobs in Rio Rancho, NM are:
What cities near Rio Rancho, NM are hiring for Utilization Review Nurse jobs? Cities near Rio Rancho, NM with the most Utilization Review Nurse job openings:
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, 66% Full Time, 12% Part Time, and 20% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $83,222 per year, or $40 per hour.

Travel Registered Nurse Utilization Management Job

Healthforce

Albuquerque, NM • On-site

Contractor

Posted 3 days ago

New

Job description

Overview
Registered Nurse - Utilization Management in a Skilled Nursing Facility setting. Albuquerque, New Mexico. Start date 08/03/2026 for a 13-week travel assignment. Weekly pay range $2,298 to $2,435 per week. Guaranteed 40 hours per week. Shift: 5x8 days (8-hour daytime shifts). This travel assignment is with Healthforce Healthcare LLC.
Key Highlights
- Weekly pay: $2,298–$2,435 per week
- Guaranteed hours: 40 per week
- Contract duration: 13 weeks
- Shift: 5x8 days (8-hour daytime shifts)
- Start date: 08/03/2026
- Setting: Skilled Nursing Facility
Responsibilities
- Conduct prospective, concurrent, and retrospective utilization reviews to support appropriate care and resource use.
- Assess medical necessity and level of care, aligning with payer guidelines and facility policies.
- Collaborate with the interdisciplinary team, including case managers and physicians, to optimize care plans and discharge planning.
- Review clinical documentation for accuracy, completeness, and timeliness; ensure compliant coding and record-keeping.
- Communicate findings, recommendations, and escalation points clearly to nursing staff and leadership as needed.
- Monitor utilization trends and participate in ongoing quality and performance improvement activities.
Requirements
- Active RN license (state-specific requirements apply).
- Utilization management or case management experience preferred.
- Knowledge of medical necessity criteria and general payer guidelines.
- Strong documentation and communication skills; ability to collaborate with a multidisciplinary team.
- Ability to work on-site in a Skilled Nursing Facility setting in Albuquerque, NM; reliable for 40 hours per week during the contract.
Benefits and Support
- 24/7 recruiter and travel support
- Credentialing and onboarding assistance
- Assignment support throughout the contract period
- Assistance with scheduling and workflow integration to fit the assignment
- Ongoing access to future assignment opportunities
Find more opportunities
If you’d like to explore additional openings, you can apply at Healthforce Healthcare LLC here: https://healthforce.applytojob.com/apply
Please note: Pay rates and guaranteed hours are estimates and may vary. Final compensation packages and confirmed hours will be discussed during the hiring process.

About Healthforce

Healthforce is a nationwide travel healthcare staffing agency connecting travel nurses and allied health professionals with high-quality contract assignments across the United States.

We specialize in placing clinicians in travel nursing jobs, allied health travel assignments, and local contract opportunities in hospitals, long-term care facilities, and outpatient settings. Whether you are an experienced traveler or taking your first assignment, Healthforce provides the support and opportunities you need to succeed.

Travel Nursing and Allied Health Opportunities Nationwide

Healthforce partners with healthcare facilities across the country to offer a wide range of opportunities for nurses and allied professionals.

  • Travel RN jobs in Med Surg, ICU, ER, LTC, and more
  • Allied health travel jobs including CT Tech, Rad Tech, PT, OT, Respiratory, and more
  • Local contract and per diem opportunities
  • Short-term and 13-week travel assignments

Our goal is simple: match you with the right assignment, in the right location, at the right pay.

What Makes Healthforce Different

We know that travel healthcare professionals have options. That is why we focus on delivering a better experience at every step of the process.

  • Competitive weekly pay packages with transparent breakdowns
  • Fast credentialing support to help you get submitted quickly
  • Dedicated recruiters who stay with you from submission to start
  • 24/7 support while you are on assignment
  • Nationwide job access across multiple specialties and care settings

We do not just place you in a job. We help you build a sustainable travel healthcare career.

Built for Travel Nurses and Allied Professionals

Healthforce is designed around the needs of today’s travel healthcare workforce. We make it easier for clinicians to move quickly, stay informed, and access strong opportunities across the country.

  • Quick submissions to open jobs
  • Access to multiple job options at once
  • Flexible assignment locations
  • Ongoing support throughout your contract

Whether you are searching for your next assignment or planning your first travel job, our team is here to help you move forward with confidence.

Start Your Next Travel Assignment

Healthforce is actively hiring travel nurses and allied healthcare professionals for assignments nationwide.

Apply today to connect with a recruiter and explore current travel nursing and allied health job opportunities.

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