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

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 ...

UNM HOSPITALS

RN CASE MANAGER

Albuquerque, NM · On-site

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

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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 Sep 13, 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.

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 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 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 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 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.

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Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Rio Rancho, NM as of September 2026, with employment types broken down into 5% As Needed, 61% Full Time, 5% Part Time, and 29% Contract. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $83,222 per year, or $40 per hour.

Registered Nurse - Senior RN Case Manager

Albuquerque, NM • On-site

Professional Case Management
Health Care and Social Assistance • 201 - 500 employees
Learn more about Professional Case Managementexternal

$46/hr

Other

Medical, Dental, Vision, Retirement, PTO

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

Professional Case Management rating

5.0

Company rating: 5.0 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

Make a Difference on Your Own Schedule and Terms!
Hiring Senior Case Managers in New Mexico
PCM is looking for a Senior Case Manager who is as passionate about delivering care as we are to come join our amazing team!
A few of our perks:
  • Great Work/Life balance!
  • $46 per hour
  • Benefits Available:
    • Medical, Vision and Dental Insurance
    • Accrued Paid Time Off
    • Travel Compensation
    • Annual Bonus Eligible
    • Health Savings Account (HSA)
    • Flexible Savings Account (FSA)
    • 401(K) with Company Match
    • Paid Parental Leave
    • Unlimited Peer Referral Program
    • Employee Discount Program
We provide in-home care to former Nuclear Weapons Workers who are suffering from chronic and terminal illnesses, as a result of their previous work environment.
Our Senior RN-Case Managers Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and with state-specific nurse practice act, and regulatory requirements.
Qualifications
  • Graduate of a state approved school of professional registered nursing
  • BSN preferred
  • Current, unrestricted RN license in the state(s) of practice
  • Minimum of two (2) years nursing experience including one (1) year in home care or closely related field
  • One (1) year of supervisory and/or case management experience preferred
  • Current CPR certification
Essential Functions/Areas of Accountability
  • Responsible for functions and accountabilities as contained in the case manager job description
  • Provide direct care and case management of assigned clients
  • Assist and collaborate with the regional director and other personnel to identify and correct issues and/or improve services.
  • Plan, implement, and evaluate care provided Participate, coordinate and manage client care conferences as needed.
  • Serve as a local on-site clinical resource as needed and provides support to ensure client's home care needs are met.
  • Assist and collaborate with staffing coordinators regarding the appropriateness of staffing and scheduling of personnel within scope of practice, competencies, client needs and complexity of home care.
  • Adhere to nursing delegation guidelines as described in Agency Scope of Practice policy.
  • Ensure adherence to Agency policies.
  • Perform other functions as requested by the regional director which may include the following:
  • Participate in interviewing, selection, and ongoing evaluation of clinical personnel as requested by the Regional Director
  • Personnel training, education, and competency validation
  • Review and evaluate clinical documentation for accuracy and completeness
  • Participate in all Agency performance improvement initiatives including but not limited to quarterly medical record review
  • Collect, document, and submit data on infections, occurrences, complaints and grievances, and performance improvement activities
  • Perform and document supervisory visits as indicated to facilitate problem resolution
  • Review nurse shift reports for adherence to policy and for opportunities for performance improvement
  • Home chart completeness
  • Timeliness of staffing cases post referral
  • Equipment tracking
  • Assist with marketing activities such as visiting with clients or physicians to discuss Agency programs as requested
  • The senior case manager, or similarly qualified alternate, shall be available at all times during operating hours and participate in all activities relevant to the professional services furnished, including the development of qualifications and the assignment of personnel.
  • Perform additional duties and responsibilities as deemed necessary

Standard Rate: $46.00 Hourly plus shift differentials, where applicable.
Please contact Rick Carey at (866) 776-0127 x350 or at rick.carey@procasemanagement.com today to learn more about our opportunities where you can make a difference in your own career!
Professional Case Management is an Equal Opportunity Employer.

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About Professional Case Management

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Since 1997, Professional Case Management (PCM) has been providing quality, nationwide in-home nursing services to sufferers of chronic diseases. We are the nation's premier healthcare provider for nuclear weapons workers, uranium miners, millers and haulers suffering from illnesses contracted in the course of their employment. Our mission is to deliver quality care to enhance patient outcomes in the privacy and comfort of their homes.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Denver, CO, US

Year founded

1986

Social media

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