Sponsors physician assistants or nurse practitioners as required. * Notifies Site Medical Director ... Actively participant of the Utilization Review process and follow proper procedures. * Other duties ...
Sponsors physician assistants or nurse practitioners as required. * Notifies Site Medical Director ... Actively participant of the Utilization Review process and follow proper procedures. * Other duties ...
Physician - Emergency Medicine/Internal Medicine/Family Medicine - Metropolitan Detention Center
Albuquerque, NM · On-site
Sponsors physician assistants or nurse practitioners as required. * Notifies Site Medical Director ... Actively participant of the Utilization Review process and follow proper procedures. * Other duties ...
Physician - Emergency Medicine/Internal Medicine/Family Medicine - Metropolitan Detention Center
Albuquerque, NM · On-site
Sponsors physician assistants or nurse practitioners as required. * Notifies Site Medical Director ... Actively participant of the Utilization Review process and follow proper procedures. * Other duties ...
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 ...
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 ...
CASE MANAGER SOCIAL WORKER - SUPERVISOR
$33.07 - $51.23/hr
... , and other health care team members * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review ...
CASE MANAGER SOCIAL WORKER - SUPERVISOR
$33.07 - $51.23/hr
... , and other health care team members * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review ...
CASE MANAGER SOCIAL WORKER - SUPERVISOR
$33.07 - $51.23/hr
... , and other health care team members * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review ...
CASE MANAGER SOCIAL WORKER - SUPERVISOR
$33.07 - $51.23/hr
... , and other health care team members * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review ...
CASE MANAGER SOCIAL WORKER - SUPERVISOR
$33.07 - $51.23/hr
... , and other health care team members * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review ...
CASE MANAGER SOCIAL WORKER - SUPERVISOR
$33.07 - $51.23/hr
... , and other health care team members * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review ...
CASE MANAGER SOCIAL WORKER - SUPERVISOR
$33.07 - $51.23/hr
... , and other health care team members * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review ...
CASE MANAGER SOCIAL WORKER - SUPERVISOR
$33.07 - $51.23/hr
... , and other health care team members * INTERVENTIONS - Monitor and evaluate short-term and long-term patient responses to interventions in collaboration with quality assurance and utilization review ...
For Nursing, must possess bachelor's degree in nursing (BSN) with RN licensure. * For other ... Three years of hospital-based Case Management experience, including Utilization Review and ...
For Nursing, must possess bachelor's degree in nursing (BSN) with RN licensure. * For other ... Three years of hospital-based Case Management experience, including Utilization Review and ...
(RN)Auditor, Healthcare Services - NCQA
Albuquerque, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Albuquerque, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Albuquerque, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Albuquerque, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Albuquerque, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Albuquerque, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Los Lunas, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Los Lunas, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Rio Rancho, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
(RN)Auditor, Healthcare Services - NCQA
Rio Rancho, NM · On-site
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... Preferred Qualifications Prior experience in clinical review/auditing of care management.
RN CASE MANAGER
$35.56 - $50.48/hr
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 ...
RN CASE MANAGER
$35.56 - $50.48/hr
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 ...
RN CASE MANAGER
$35.56 - $50.48/hr
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 ...
RN CASE MANAGER
$35.56 - $50.48/hr
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 ...
RN CASE MANAGER
$35.56 - $50.48/hr
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 ...
RN CASE MANAGER
$35.56 - $50.48/hr
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 ...
RN CASE MANAGER
$35.56 - $50.48/hr
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 ...
RN CASE MANAGER
$35.56 - $50.48/hr
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 ...
Resource Nurse
$80K - $100K/yr
... utilization, and overall patient outcomes. This role also includes connecting patients with ... Care plan review, planning and coordination of care * Provide education to the patient, their ...
Quick apply
Resource Nurse
$80K - $100K/yr
... utilization, and overall patient outcomes. This role also includes connecting patients with ... Care plan review, planning and coordination of care * Provide education to the patient, their ...
Utilization Review Nurse information
See Rio Rancho, NM salary details
$20.25 - $24.34
2% of jobs
$24.34 - $28.43
9% of jobs
$31.24 is the 25th percentile. Wages below this are outliers.
$28.43 - $32.53
21% of jobs
The median wage is $35.84 / hr.
$32.53 - $36.62
23% of jobs
$36.62 - $40.72
13% of jobs
$43.90 is the 75th percentile. Wages above this are outliers.
$40.72 - $44.81
10% of jobs
$44.81 - $48.91
8% of jobs
$48.91 - $53
5% of jobs
$53 - $57.10
5% of jobs
$57.10 - $61.19
2% of jobs
$61.19 - $65.28
2% of jobs
$20
$40
$65
How much do utilization review nurse jobs pay per hour?
As of Jul 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.
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?
| Aspect | Utilization Review Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certification in utilization review (e.g., URAC) | RN license, case management certification (e.g., CCM) |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, insurance companies, community health settings |
| Employer & Industry Usage | Primarily in insurance and healthcare organizations for reviewing medical necessity | In 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:
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:
Physician - Emergency Medicine/Internal Medicine/Family Medicine - Metropolitan Detention Center
Albuquerque, NM
Other
Re-posted 13 days ago
Job description
UNM Medical Group, Inc. is hiring an Emergency Medicine, Internal Medicine, or Family Medicine Physician for the Metropolitan Detention Center. This opportunity is a full-time (1.0FTE) opening located at Metropolitan Detention Center (MDC) in Albuquerque, New Mexico.
***Board certified or board eligible in Family Practice, Internal Medicine, Emergency Medicine is required.
Summary:
UNM Medical Group, Inc. is seeking staff physicians to serve full-time as a provider at the MDC. Providers have the opportunity to impact care at the MDC in accordance with nationally recognized standards of care. Physicians at the MDC will provide direct patient care in the chronic care clinic, acute care setting, or the newly created addiction medicine clinic. Providers will participate in CQI, Morbidity and Mortality review, clinical practice guidelines, policy and procedures, and compliance initiatives related to the McClendon court ordered decree.
Minimum Job Requirements of a Family Practice, Internal Medicine, or Emergency Medicine Staff Physician:
Medical doctor with 3 to 5 years of directly related experience which may include residency in a directly related medical specialty. State of New Mexico and Federal DEA Certification; Medical Specialty License or Certification; Board Certified or Board Eligible in the specified area of medical specialty. Verification of education and licensure (if applicable) will be required if selected for hire.
Duties and Responsibilities of a Family Practice, Internal Medicine, or Emergency Medicine Staff Physician:
- Provides typical community standard care based on evidenced based medicine for clinical services required including but not limited to sick call, chronic care, history and physicals, and all emergency care needs. When applicable, visits the infirmary daily and documents encounters in patient's Medical Record as assigned. The goal is to provide the right care, at the right time, and at the right location in accordance with national standards and the McClendon Agreement.
- Will provide call as needed for the role.
- Adheres to approved formulary for therapeutic regimens before utilizing non-formulary procedure.
- Utilizes available in-house resource personnel for treatment or resolution of identified problems before utilizing off-site referral. Provides emergency treatment on-site and responds appropriately in urgent or emergency situations.
- Demonstrates proper technique for cardiopulmonary resuscitation and related drug therapy with certification as required by credentialing.
- Supports standards of medical care through adherence to existing policies and procedures. Serves as a resource to other professional or non-professional personnel providing instructions as needed.
- Attends Medical Staff meetings as required. Provides monthly in-service education of staff as requested. Participates in monthly review of quality of care and chart reviews as requested. Sponsors physician assistants or nurse practitioners as required.
- Notifies Site Medical Director and/or Site Health Services Administrator of schedule changes. Assists in arrangement for coverage of medical services if unavailable for extended period of time.
- Participates in all quality improvement measures including sentinel event review.
- Actively participant of the Utilization Review process and follow proper procedures.
- Other duties as requested by the Site Medical Director.
About UNM Medical Group, Inc.
Since our creation in 2007, our dynamic organization has continued to grow and form strong partnerships within the UNM Health system. We ASPIRE to incorporate the following values into all aspects of our culture and work: we always demonstrate an Attitude of Service with Positivity, Integrity and Respect as we strive for Excellence.
-Fully paid malpractice insurance
Apply TODAY to our Staff Physician opportunity with the UNM Medical Group, Inc. and our Physician Recruiter will contact you shortly!