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Utilization Review Rn Jobs in New Mexico (NOW HIRING)

Prime Staffing

Travel RN Case Manager

Albuquerque, NM · On-site

Prime Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Albuquerque ... Utilization Review Admission Criteria Care coordination Discharge Planning Utilize InterQual ...

UnitiMed

RN Case Manager

Albuquerque, NM · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

HAN Staff

RN - Case Manager

Portales, NM · On-site

$2.3K/wk

Routine case management, discharge planning, swing bed coordinator and utilization review duties ... Active NM State Registered Nurse License * Valid BLS * Graduate of an Accredited School of Nursing

UNMHSCHS

RN CASE MANAGER

Albuquerque, NM · On-site

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

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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 Jul 12, 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:
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 July 2026, with employment types broken down into 1% As Needed, 79% Full Time, 15% Part Time, 1% Temporary, and 4% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $85,227 per year, or $41 per hour.

RN - Manager of Clinical Access Case Manager

HiredFirst

Farmington, NM • On-site

Full-time

Posted 9 days ago

Job description

A Clinical Access Case Manager (RN) opportunity is available in Farmington, NM at a 198-bed, Level III trauma center serving the Four Corners region of New Mexico, Arizona, Colorado, and Utah. The facility holds PCI, Mammography, and Laboratory accreditation and offers a broad spectrum of services including medical, surgical, rehabilitation, a childbirth center, cancer center, nephrology unit, pediatric unit, inpatient behavioral health, day surgery, and extensive imaging and lab services.
The role. This is a hospital-wide case management position focused on utilization management and clinical access. The nurse in this role applies InterQual criteria and utilization review and management principles across all patient populations to support appropriate admission status, care transitions, and resource utilization. Day-to-day work involves collaborating with clinical teams throughout the facility to ensure timely and accurate level-of-care determinations. The position requires at least 2 years of acute care experience and operates within a Cerner and InterQual EHR environment.
What we're looking for.
• Associates in Nursing or higher
• Minimum 2 years of acute care experience
• Experience with InterQual and Utilization Review/Management required
• Experience with CCM, ACM, or Milliman preferred
• BLS required upon submission
• All other required certifications can be obtained after hire
• Open to candidates who do not hold New Mexico or Compact licensure; candidates must obtain licensure prior to start
Schedule. Days.
Compensation. $31.00 - $46.50/hr plus $2 sign-on bonus