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Utilization Review Rn Jobs in New Mexico (NOW HIRING)

Hired by Matrix

RN Utilization Review

Portales, NM · On-site

Job Title: RN Utilization Review City: Portales State: NM Job Type: Travel Discipline: RN Speciality: Utilization Review Facility Setting: Short Term Actut Care (STAC) Accepting Locals per Radius ...

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How much do utilization review rn jobs pay per hour?

As of Aug 21, 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.

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.

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.

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 get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

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:

What are popular job titles related to Utilization Review Rn jobs in New Mexico?

For Utilization Review Rn jobs in New Mexico, the most frequently searched job titles are:

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 August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $85,227 per year, or $41 per hour.

RN Utilization Review

Hired by Matrix

Portales, NM • On-site

Other

Re-posted just now

Job description

Job Title: RN Utilization Review
City: Portales
State: NM
Job Type: Travel
Discipline: RN
Speciality: Utilization Review
Facility Setting: Short Term Actut Care (STAC)
Accepting Locals per Radius Rule?: Yes
Contract Length: 13 weeks
Shifts: Days
Shift Details: Day 5x8-Hour
Weekly Schedule: 40 Hours
Certifications/License: Mandatory Experience:
  • Routine case management, discharge planning, swing bed coordinator and utilization review duties.
  • Evaluating and screening potential admissions to the facilities swing bed program
  • knowledgeable of criteria for Medicare, Medicaid, HMO, swing bed and private insurance coverage
  • Initiate ongoing communication with the resident and resident's family to assess discharge needs.
  • Actively involvement in daily rounds with bedside staff, physicians and ancillary team members
  • Communicate with physicians to ascertain their plans for a timely discharge.
  • document updates and discharge planning as an ongoing review.
  • Manage and collaborate with the healthcare team on swing bed placement and complete MDS documentation as necessary.
  • assist with obtaining referrals, prior authorization for Home Health Care, CME, SNF, acute rehab and appointments.
  • Educates physicians and staff regarding appropriate level of care/utilization and required documentation that meets admission status
  • Run Interqual for each IP and OBS patient admitted to the floor
Get in Touch:
We want to hear from you! If you think you'd be a good match, submit your resume and reach out to Shrishti at (201) 366-0647 to learn more.

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