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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 ...

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 ...

Prime Staffing

Travel Case Manager

Rio Rancho, NM · On-site

Active State or Compact RN License Certifications: BLS - AHA Must-Have: Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care ...

New

Cibola General Hospital

RN Registered Nurse

Grants, NM · On-site

$40 - $60/hr

Nursing Administration Roles Case Manager / Utilization Review Nurse (RN) Is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This ...

Cibola General Hospital

RN Registered Nurse

Grants, NM · On-site

$40 - $60/hr

Nursing Administration Roles Case Manager / Utilization Review Nurse (RN) Is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This ...

UNMHSCHS

RN CASE MANAGER

Rio Rancho, NM · On-site

... staff RNs and other health care team members * PLAN OF CARE - Develop comprehensive ... utilization review, maintaining interdependent follow-up as necessary * TREATMENT CONFERENCE ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in New Mexico

Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Aug 22, 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-Case Manager

MTK Healthcare

Portales, NM • On-site

$59 - $62/hr

Contractor

Re-posted 13 days ago

Job description

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 Review & Swing Bed

  • Location: Portales, NM 88130

  • Contract Length: 13 Weeks

  • Shift: Monday–Friday, 8:00 AM–4:30 PM (Day Shift)

  • Pay Rate: $59–$62/hour

  • Guaranteed Hours: 40 Hours per Week

  • No On-Call Required

Requirements

  • Active RN License

  • Minimum 5 years of Case Management experience

  • Experience in Utilization Review and Discharge Planning

  • Knowledge of Medicare, Medicaid, HMO, Swing Bed, and Private Insurance coverage

  • Experience with InterQual criteria and MDS documentation
    Key Responsibilities

  • Perform utilization review, case management, discharge planning, and swing bed coordination.

  • Evaluate and screen patients for swing bed admissions.

  • Coordinate discharge planning with patients, families, physicians, and the interdisciplinary care team.

  • Obtain referrals and prior authorizations for post-acute services.

  • Complete utilization reviews and ensure appropriate level of care documentation.

  • Run InterQual reviews for inpatient and observation admissions.

  • Collaborate with healthcare providers to ensure timely, safe, and effective patient transitions.