Clinical Utilization Review Nurse Specialist

3 days ago


Albuquerque, New Mexico, United States University of New Mexico - Hospitals Full time
About the Role

We are seeking a skilled Clinical Utilization Review Nurse Specialist to join our team at the University of New Mexico - Hospitals.

Job Summary

The Clinical Utilization Review Nurse Specialist will be responsible for coordinating patient care, managing insurance authorizations, and ensuring quality cost-effective care for patients. This role requires strong clinical knowledge, excellent communication skills, and the ability to work collaboratively with healthcare teams.

Responsibilities
  • Coordinate all systems and services required for organized, multidisciplinary patient-centered care
  • Manage insurance authorizations and ensure timely processing
  • Collaborate with physicians, nurses, and other staff to achieve quality patient outcomes
  • Conduct initial and ongoing assessments, initiate disease management protocols, and determine patient outcomes
  • Ensure continuity of care through discharge planning and resource utilization analysis
Requirements
  • 1 year directly related experience as a Registered Nurse
  • RN licensure in New Mexico or reciprocal agreement by NM
  • CPR for Healthcare/BLS Provider certification within 30 days
Working Conditions

This is a light work position requiring occasional lifting up to 20 pounds, standing, and walking. Minor hazards include physical risks, dirt, dust, fumes, and noise.

Benefits

We offer competitive salary and benefits packages, including health insurance, retirement plans, and paid time off.

Estimated Salary

$85,000 per year based on location and industry standards.



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