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Utilization Review Rn Jobs in New Mexico (NOW HIRING)

1 Legacy, Inc

Full Time UM RN

Clovis, NM

Company Description Skilled Nursing Facility A leading provider of nursing and rehabilitation ... utilization of hospital services. Accountabilities: Performs medical record reviews for severity of ...

The Grey Group

Registered Nurse

Las Cruces, NM · On-site

Registered Nurse to function as our Medical Surgical RN. The Med/Surg RN is a competent, registered, professional nurse who delivers care to the patient through utilization of the nursing process ...

The Grey Group

Registered Nurse

Las Cruces, NM · On-site

Registered Nurse to function as our Medical Surgical RN. The Med/Surg RN is a competent, registered, professional nurse who delivers care to the patient through utilization of the nursing process ...

UNMHSCHS

RN CASE MANAGER SUPERVISOR

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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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.

Rehabilitation Liaison - Acute Physical Rehab

CHRISTUS Health

Santa Fe, NM • On-site

Full-time

Posted 23 days ago

CHRISTUS Health rating

6.7

Company rating: 6.7 out of 10

Based on 531 frontline employees who took The Breakroom Quiz

532nd of 891 rated healthcare providers

Job description

Description

Summary:

The Rehab Liaison evaluates and assesses potential candidates and facilitates the admission process for patients appropriate for CHRISTUS St. Vincent Hospital’s Inpatient Rehabilitation Program. This individual also negotiates length of stay with managed care organizations and performs Utilization Review functions. Serves as liaison with local and surrounding communities and providers, enhancing their knowledge and awareness of Rehabilitation Services at St. Vincent. Serves as a rehabilitation nurse consultant, with attention to the clients rehabilitation potential, therapy and functional progress , discharge plan and feasibility, special equipment needs, rehabilitation services across the continuum of care, and care transitions. Serves as contact person for the rehabilitation team, internal admissions team, clients and external sources to enhance outcomes. 

Requirements:

EDUCATION: Degree in nursing. (BSN Preferred)

LICENSES/CERTIFICATIONS: Current licensure as a Registered Nurse, (Certified Rehabilitation Registered Nurse, Preferred)

SKILLS: Demonstrated accountability and skills in assessment/evaluation, decision making, time management, and oral and written communication with individuals and groups. Must also posses working familiarity with rehabilitation levels of care, as well as with the current managed care environment related to those settings.

EXPERIENCE: Five years of nursing experience, with at least two of those years in a inpatient rehabilitation setting. It is recommended that the individual also possess at least two years of experience in management or a managed care role. Experience in marketing, public relations, or community education activities preferred. Experience with third party payor requirements, resources and parameters also preferred. 

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time


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Hours and flexibility

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About CHRISTUS Health

Sourced by ZipRecruiter

CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.

Industry

Outpatient health care

Company size

1,001 - 5,000 Employees

Headquarters location

Irving, TX, US

Year founded

1999

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