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

Utilization Management *SRMC Care Management *Full Time *Part Time Receive 17% Weekday Nights, 26 ... This is supported by a chart review for the level of care and correcting billing aspects of care ...

... are utilization. Together with our health plan partners, we are changing the way our society ... Such requests will be subject to review and approval by the Company, and exemptions will be granted ...

... review and revision of plan of care; 3. Provision of Direct Patient Care: 3.1. Administers ... RN, participates in Utilization Management or Interdisciplinary Care Management Meeting to ...

New

Travel LPN

Albuquerque, NM

$25 - $34/hr

Participates in review and revision of plan of care; * Provision of Direct Patient Care ... At the direction of the RN, participates in Utilization Management or Interdisciplinary Care ...

New

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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.

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:
Case Management Director II

Other

Medical, Dental, Vision, Retirement, PTO

Posted 23 days ago


Encompass Health rating

6.9

Company rating: 6.9 out of 10

Based on 404 frontline employees who took The Breakroom Quiz

452nd of 870 rated healthcare providers


Job description

Case Management Director Career Opportunity

Highly regarded for your Case Management Director expertise

Are you an experienced and compassionate healthcare professional with a background in case management, seeking a career that aligns with your professional expertise and resonates with your personal values? As the Director of Case Management at Encompass Health, you have the unique opportunity to lead a team and make a profound impact on the lives of individuals within your local community. This role combines fulfilling career opportunities close to home with the chance to make a meaningful difference in the well-being of those around you. Join us in this journey of care, compassion, and leadership as we work together to make a difference where it matters most, serving as a key member of our leadership team overseeing the day-to-day operations and management of our Case Management department.

A Glimpse into Our World

At Encompass Health, you'll experience the difference the moment you become a part of our team. Being at Encompass Health means aligning with a rapidly growing national inpatient rehabilitation leader. We take pride in the growth opportunities we offer and how our team unites for the greater good of our patients. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For Award, among other accolades, which is nothing short of amazing.

Starting Perks and Benefits

At Encompass Health, we are committed to creating a supportive, inclusive, and caring environment where you can thrive. From day one, you will have access to:

  • Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.

  • Generous paid time off that accrues over time.

  • Opportunities for tuition reimbursement and continuing education. 

  • Company-matching 401(k) and employee stock purchase plans.

  • Flexible spending and health savings accounts.

  • A vibrant community of individuals passionate about the work they do!


Become the Case Management Director you've always aspired to be

  • Assume responsibility for the day-to-day operations and human resource management of the Case Management department.

  • Oversee the interdisciplinary plan of care and the discharge planning process to ensure the effectiveness and appropriateness of services with a central focus on census management, patient care outcomes, and key care indicators.

  • Act as a patient and family advocate, ensuring that services are delivered to meet the needs of patients and their families.

  • Provide guidance and support to Case Managers and other staff, including training on managing caseloads and interpreting regulations, policies, operational procedures, and objectives. Review operations to ensure a high level of quality consistent with organizational standards.

  • Build relationships with insurance companies, self-insured employers, case management firms, and other healthcare networks.

  • Celebrate the accomplishments and successes of our dedicated employees along the way.


 Qualifications

  • Current CCM or ACMTM certification is preferred.

  • Must be qualified to independently complete an assessment within the scope of practice of his/her discipline.

  • If licensure is required for the discipline within the hospital's state, individual must hold an active license.

  • For Nursing, must possess bachelor's degree in nursing (BSN) with RN licensure.

  • For other eligible health care professionals, must possess a minimum of a bachelor's degree; a graduate degree is preferred.

  • Three years of hospital-based Case Management experience, including Utilization Review and Discharge Planning experience.

  • May be required to work weekdays and/or weekends, evenings and/or night shifts.

  • May be required to work on religious and/or legal holidays on scheduled days/shifts.

The Encompass Health Way

We proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!

At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.

We're eager to meet you, and we genuinely mean that. Join us on this remarkable journey!


What Encompass Health employees say

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Get the full story on Breakroom


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About Encompass Health

Sourced by ZipRecruiter

Helping patients regain hope and independence, Encompass Health is a national leader in post-acute care. We operate rehabilitation hospitals in 36 states as well as Puerto Rico. Following the Encompass Way, we are driven by our core values: We proudly set the standard, lead with empathy, do what's right, focus on the positive, and remain stronger together.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Birmingham, AL, US

Year founded

1984