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

UMR

RN - Sr. Clinical Case | , NM

Albuquerque, NM · On-site

Valid NM RN License or valid multi-state compact license * Current BLS Certification * 3+ years of ... and/or utilization review functions within health plan or integrated system Knowledge/Skills ...

Encompass Health

Case Manager

Albuquerque, NM · On-site

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Encompass Health

Case Manager

Albuquerque, NM

$19.50 - $25/hr

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Encompass Health Corporation

Case Manager

Albuquerque, NM · On-site

$18.25 - $23.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

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All JobsUtilization Review Nurse JobsUtilization Review Nurse Jobs in Rio Rancho, NM

Utilization Review Nurse information

See Rio Rancho, NM salary details

$19

$38

$62

How much do utilization review nurse jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for utilization review nurse in Rio Rancho, NM is $38.13, according to ZipRecruiter salary data. Most workers in this role earn between $30.14 and $43.80 per hour, depending on experience, location, and employer.

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 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.

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:
What are popular job titles related to Utilization Review Nurse jobs in Rio Rancho, NM? For Utilization Review Nurse jobs in Rio Rancho, NM, the most frequently searched job titles are:
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
Travel RN Case Manager - $2,524 per week

Travel RN Case Manager - $2,524 per week

American Traveler

Albuquerque, NM • On-site

$2K/wk

Other

Medical, Dental, Vision, Life, Retirement

This job post has expired today. Applications are no longer accepted.

Job description

American Traveler is seeking a travel nurse RN Case Management for a travel nursing job in Albuquerque, New Mexico.

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Start Date: 07/06/2026
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel
Assignment Overview
  • Shift: Days, 5x8hrs
  • Hours: 40 hrs/wk
  • Start Date: Jul 6, 2026
  • Length: 13 weeks
  • Openings: 1
Description

American Traveler is hiring a travel RN - Case Manager for an inpatient acute care position at a Level I Trauma, Teaching, and Children's Hospital in New Mexico, requiring at least 2 years of case management experience and a valid NM or compact RN license.

Details
  • Inpatient case management unit serving both adult and pediatric patient populations
  • Level I Trauma, Teaching, and Children's Hospital with 554 staffed beds
  • Patient caseload ratio of 1:25
  • Schedule is 5x8s, Monday through Friday, with weekend shifts (Saturday and Sunday) on a 4x10 schedule
  • Charting in Cerner and Midas/Care Port
  • Floating within scope required to meet facility needs
  • No on-call requirements
  • Free parking available on-site
Requirements
  • Active NM or compact RN license required; pending license accepted
  • Current BLS certification required
  • Minimum 2 years of case management experience in an inpatient acute care setting
  • Inpatient acute care experience required
  • COVID vaccination required; religious and medical exemptions accepted with a completed exemption form signed by a provider
Additional Information
  • First-time travelers are welcome if they have acute care case management experience
  • Candidates must reside more than 100 miles from the facility to be eligible
  • RTO requests exceeding 7 days require approval
  • All time off and scheduling requests must be submitted at the time of initial consideration
  • Block scheduling is not available for this position
  • A 6-month break is required for travelers who have completed 4 consecutive assignments or reached the one-year mark at this facility, whichever comes first
  • Scrubs are optional black or business casual attire
  • New contracts and extensions must be a minimum of 10 weeks

American Traveler Job ID #P-710501. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management

About American Traveler

With over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.

With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.

American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.

With our team behind you, you can relax and enjoy a rewarding travel career.

Why Vivian Health?

Be sure to apply via Vivian Health to increase your chances of landing your perfect job. Just complete your Vivian Health profileonce, and get access to thousands of opportunities across the country. Then keep up to date with your job application process and conversations with our easy to use app.

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