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Utilization Review Rn Jobs in New Mexico (NOW HIRING)

MTK Healthcare

RN-Case Manager

Portales, NM · On-site

$59 - $62/hr

MTK Healthcare Inc. is Hiring RN Case Manager - Utilization Review & Swing Bed | Portales, NM | Monday-Friday (8:00 AM-4:30 PM), Day Shift Position Details * Position: RN Case Manager - Utilization ...

Presbyterian Healthcare Services

Current State of New Mexico Registered Nurse licensure required. * 2 years clinical nursing experience in relevant clinical practice area with utilization review or case management experience ...

Phsorg

Current State of New Mexico Registered Nurse licensure required. * 2 years clinical nursing experience in relevant clinical practice area with utilization review or case management experience ...

Presbyterian Healthcare Services

$36.41 - $62/hr

Current State of New Mexico Registered Nurse licensure required. * 2 years clinical nursing experience in relevant clinical practice area with utilization review or case management experience ...

Phsorg

$36.41 - $62/hr

Current State of New Mexico Registered Nurse licensure required. * 2 years clinical nursing experience in relevant clinical practice area with utilization review or case management experience ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in New Mexico

Utilization Review Rn information

See New Mexico salary details

$20

$40

$66

How much do utilization review rn jobs pay per hour?

As of Aug 1, 2026, the average hourly pay for utilization review rn in New Mexico is $40.97, according to ZipRecruiter salary data. Most workers in this role earn between $32.40 and $47.07 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in New Mexico? The most popular types of Utilization Review Rn jobs in New Mexico are:
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What job categories do people searching Utilization Review Rn jobs in New Mexico look for? The top searched job categories for Utilization Review Rn jobs in New Mexico are:
What are popular job titles related to Utilization Review Rn jobs in NM? For Utilization Review Rn jobs in NM, the most frequently searched job titles are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in New Mexico as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 1% Temporary, and 4% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $85,227 per year, or $41 per hour.

Registered Nurse Utilization Review- Rn Case Management (IN PERSON)- Sign on Bonus

i4 Search Group Healthcare

Alamogordo, NM

$33 - $50/hr

Full-time

Re-posted 29 days ago

Job description









Position: UTILIZATION REVIEW RN- Case Management (IN PERSON) - SIGN ON BONUS

Location: Alamogordo, NM **Onsite- In person (40 HRS)

Schedule: Days


Responsibilities:

  • Meets expectations aligned with organizational competency models, including Leader of Self, Leader of Others, or Leader of Leaders.
  • Conducts prior authorization reviews to assess whether proposed services are covered and medically necessary for the beneficiary.
  • Promotes quality, cost-effective outcomes through prior authorization and concurrent review using evidence-based clinical guidelines.
  • Identifies and escalates cases involving potential quality of care concerns, questionable admissions, or extended lengths of stay to the Medical Director.
  • Refers beneficiaries with complex or chronic conditions for care coordination, including transition of care, disease management, and behavioral health support as appropriate.
  • Adheres to all applicable HIPAA regulations to ensure the privacy and security of Protected Health Information (PHI).
  • Maintains confidentiality of sensitive data and ensures compliance with national health information standards.
  • Reviews and analyzes clinical documentation submitted by providers to determine medical necessity, appropriateness, and efficiency of services, procedures, and facility use.
  • Conducts provider outreach to coordinate post-discharge care, encourage use of in-network services, support durable medical equipment needs, and perform necessary follow-up.
  • Applies the nursing process and critical thinking skills to oversee services and evaluate care options.



Job Requirements:

  • Graduate of an accredited vocational nursing program or equivalent required
  • Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) preferred

Experience:

  • 3–5 years of nursing experience preferred
  • Proficiency with Microsoft Office applications (Outlook, Teams, Word, Excel) required
  • General computer proficiency required

Licenses/Certifications:

  • Active LVN license in the state of employment or compact license required
  • Active RN license in the state of employment or compact license preferred