Current jobs related to RN - Utilization Review Specialist - Albuquerque, New Mexico - University of New Mexico - Hospitals

  • RN - Utilization Review Specialist

    4 weeks ago

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

    Job SummaryWe are seeking a skilled RN to join our Utilization Review team as a Per Diem Case Manager. This role will involve reviewing admissions and continued stays to ensure medical necessity and managing insurance authorization throughout the hospital stay.Key ResponsibilitiesCoordinate all systems and services required for an organized,...

  • RN - Utilization Review Specialist

    2 weeks ago

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

    Job DescriptionUNM Hospitals participates in the Clinical Advancement Program (CAP) and depending on your Nursing Education and National Certifications, you'll work towards one of five CAP levels that offer increasing compensation. You may earn up to 8.00 in addition to base pay.Sign-on Bonus and Relocation Reimbursement availableAs a Utilization Review...

  • Utilization Management Nurse Specialist

    3 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Job Title: Utilization Management Nurse SpecialistWe are seeking a skilled Utilization Management Nurse Specialist to join our team at Presbyterian Healthcare Services. As a Utilization Management Nurse Specialist, you will play a critical role in ensuring that services rendered to members meet clinical criteria and are delivered in the appropriate...

  • Registered Nurse

    4 weeks ago

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

    Job SummaryWe are seeking a skilled Registered Nurse to join our Utilization Review team at the University of New Mexico - Hospitals. As a Utilization Review Registered Nurse, you will play a critical role in reviewing admissions and continued stays to ensure medical necessity and manage insurance authorization throughout the stay.Key...

  • RN - Utilization Review Case Manager Per Diem

    2 weeks ago

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

    Job SummaryWe are seeking a skilled RN to join our Utilization Review team as a Case Manager Per Diem. In this role, you will be responsible for reviewing admissions and continued stays to ensure medical necessity and managing insurance authorization throughout the hospital stay.Key ResponsibilitiesCoordinate all systems and services required for an...

  • Clinical Utilization Management Nurse Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Job SummaryWe are seeking a skilled Utilization Management Nurse Specialist to join our team at Presbyterian Healthcare Services. As a key member of our healthcare team, you will play a vital role in ensuring that our patients receive the highest quality care while minimizing unnecessary costs.Key Responsibilities• Perform clinical reviews to ensure that...

  • Utilization Management Specialist

    4 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Job Title: Utilization Management Reviewer-Long Term CareJob Summary:We are seeking a highly skilled Utilization Management Reviewer-Long Term Care to join our team at Presbyterian Healthcare Services. As a Utilization Management Reviewer-Long Term Care, you will be responsible for conducting thorough reviews of medical documentation to determine the medical...

  • Water Utility Trainer and Specialist

    4 weeks ago

    Albuquerque, New Mexico, United States University of New Mexico Full time

    Job Title: Water Utility Trainer and SpecialistWe are seeking a highly skilled Water Utility Trainer and Specialist to join our team at the University of New Mexico. As a key member of our Center for Water and the Environment, you will be responsible for providing training and technical assistance to small water, wastewater, and stormwater utilities in EPA...

  • Utilization Management Specialist

    3 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Job SummaryWe are seeking a skilled Utilization Management Specialist to join our team at Presbyterian Healthcare Services. As a Utilization Management Specialist, you will play a critical role in ensuring that our members receive the most appropriate and cost-effective care possible.Key Responsibilities:Conduct thorough reviews of medical documentation to...

  • HEDIS Review Nurse Specialist

    2 months ago

    Albuquerque, New Mexico, United States w3r Consulting Full time

    Job Summary:An experienced Registered Nurse (RN) is sought to join our team at w3r Consulting as a HEDIS Review Nurse. The successful candidate will be responsible for conducting annual patient chart inspections/audits to ensure compliance with standards of patient care set forth by insurance companies.Key Responsibilities:Abstract medical record...

  • Utilization Management Specialist

    4 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Job Title: Utilization Management Reviewer-Long Term CarePresbyterian Healthcare Services is seeking a skilled Utilization Management Reviewer-Long Term Care to join our team. As a key member of our healthcare team, you will be responsible for conducting thorough reviews of medical documentation to ensure that services rendered to members meet Long Term Care...

  • Utilization Management Specialist

    3 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Job SummaryPresbyterian Healthcare Services is seeking a skilled Utilization Management Specialist - Long Term Care to join our team. In this role, you will be responsible for conducting thorough reviews of medical documentation to determine the level of care required for patients in long-term care facilities. Your expertise in utilization management and...

  • Regional UM Registered Nurse

    2 weeks ago

    Albuquerque, New Mexico, United States Wexford Health Sources Full time

    Job SummaryWexford Health Sources is seeking a highly skilled Utilization Management Nurse to join our team. As a key member of our healthcare team, you will play a critical role in ensuring cost-effective outcomes while maintaining a focus on quality care for inpatient and/or outpatient services.Key ResponsibilitiesMonitor on-going medical needs and...

  • Plumbing and Utility Specialist

    3 weeks ago

    Albuquerque, New Mexico, United States TLC Plumbing & Utility Full time

    TLC Plumbing & Utility is a leading company with a strong culture, and we are always looking for skilled individuals to fill key roles.Our mission is to provide a stable work environment while being respected among our peers. This is supported by our core values of honesty, hard work, respect, compassion, and consistency.We have helped numerous individuals...

  • RN - Case Management IV - Care Coordination Specialist

    3 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Care Coordination RN - Case Management IVWe are seeking a highly skilled RN Case Manager IV to join our team at Presbyterian Healthcare Services. As a key member of our care coordination team, you will play a vital role in ensuring the delivery of effective and efficient patient care.Key Responsibilities:Provide clinically-based case management to support...

  • RN - Case Management IV - Care Coordination Specialist

    1 month ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Care Coordination RN - Case Management IVWe are seeking a highly skilled RN Case Manager IV to join our team at Presbyterian Healthcare Services. As a key member of our care coordination team, you will play a vital role in ensuring the delivery of effective and efficient patient care.Key Responsibilities:Provide clinically-based case management to support...

  • RN - Case Manager - Care Coordination Specialist

    2 weeks ago

    Albuquerque, New Mexico, United States Presbyterian Healthcare Services Full time

    Care Coordination RN - Case Manager Job SummaryThe Presbyterian Healthcare Services is seeking a skilled RN - Case Manager to join our team. As a RN - Case Manager, you will be responsible for providing clinically-based case management to support the delivery of effective and efficient patient care.Key Responsibilities:Integrate utilization management, care...

  • Travel Nurse RN Specialist

    3 weeks ago

    Albuquerque, New Mexico, United States Planet Healthcare Full time

    Job Title: Travel Nurse RN SpecialistPlanet Healthcare is seeking a travel nurse RN specialist for a challenging opportunity in Albuquerque, New Mexico.Job Requirements:Specialty: PCU - Progressive Care UnitDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelAs a travel nurse RN specialist, you will have the...

  • RN - Intermediate Care Specialist

    3 weeks ago

    Albuquerque, New Mexico, United States Lovelace Medical Center Full time

    Job Title: RN - Intermediate Care SpecialistJob Summary: We are seeking a skilled RN - Intermediate Care Specialist to join our team at Lovelace Medical Center.Responsibilities:* Provide high-quality patient care in the IMC unit* Collaborate with the healthcare team to develop and implement patient care plans* Conduct thorough assessments and evaluations of...

  • Clinical Education Specialist RN

    2 weeks ago

    Albuquerque, New Mexico, United States University of New Mexico Full time

    Clinical Education Specialist RNAs a Clinical Education Specialist RN at the University of New Mexico, you will play a crucial role in developing and leading education programs for specialized patient care within clinical protocols. Using evidenced-based research and national standards, you will train staff and students, and perform clinical instruction on...

RN - Utilization Review Specialist

2 months ago

Albuquerque, New Mexico, United States University of New Mexico - Hospitals Full time
Job Summary

We are seeking a skilled RN to join our team as a Utilization Review Specialist. This per diem position will play a critical role in ensuring the quality and cost-effectiveness of patient care.

Key Responsibilities
  • Conduct thorough assessments of patient needs and develop comprehensive care plans
  • Collaborate with healthcare teams to ensure seamless transitions of care
  • Monitor and analyze patient outcomes to identify areas for improvement
  • Develop and implement strategies to optimize resource utilization and reduce costs
  • Provide education and support to patients and families to promote self-management and independence
Requirements
  • Current RN licensure in New Mexico or eligibility for reciprocal agreement
  • 1 year of direct experience in utilization review or case management
  • Excellent communication and interpersonal skills
  • Ability to work independently and as part of a team
  • Strong analytical and problem-solving skills
Working Conditions

This is a per diem position, and the RN will work on an as-needed basis. The work environment is fast-paced and dynamic, with a focus on providing high-quality patient care.

The University of New Mexico - Hospitals is an equal opportunity employer and welcomes applications from diverse candidates.