Job Description

Shape the future of patient access and quality in a role where clinical judgment truly matters. The Utilization Review Case Management RN Nurse will join a forward-moving New Mexico regional medical center that rewards innovation, collaboration, and results ✨🩺.

Why this organization stands out The Utilization Review Case Management RN Nurse will thrive within an award-winning, nationally recognized hospital known for patient safety excellence, advanced EHR capabilities, AI-supported clinical decision tools, and rapidly expanding telehealth services. The Utilization Review Case Management RN Nurse will contribute to service lines supported by cutting-edge imaging, minimally invasive procedures, and Centers of Excellence, all backed by robust quality scores, accreditation achievements, and deep community partnerships that include health equity initiatives, bilingual outreach, and substantial support for underserved populations.

Structure, support, and day-to-day impact The Utilization Review Case Management RN Nurse will report to a dedicated Director of Case Management with strong collaboration from a Utilization Management leader, Revenue Integrity, and Clinical Documentation Improvement, while working shoulder-to-shoulder with friendly nurses, case managers, social workers, hospitalists, and a diverse healthcare professional team. The Utilization Review Case Management RN Nurse will perform concurrent review using InterQual/MCG, steward length of stay and throughput, verify medical necessity, prevent denials, coordinate appeals, partner with payers, and drive compliant documentation that supports the revenue cycle and evidence-based care. The Utilization Review Case Management RN Nurse will be supported with preceptorship, continuing education, certification assistance (ACM/CCM/CPUR), modern analytics dashboards, secure payer portals, and an enterprise EHR—ensuring the role remains impactful, efficient, and well-resourced.

Live, work, and explore New Mexico The Utilization Review Case Management RN Nurse will enjoy a lifestyle defined by 300 days of sunshine, striking high-desert vistas, and four true seasons—perfect for hiking, skiing, mountain biking, hot springs, river rafting, and national park adventures from the Rio Grande to other scenic treasures. The Utilization Review Case Management RN Nurse will discover a vibrant arts and music scene with year-round concerts and festivals, a rich blend of cultures and history, and a culinary landscape famed for red and green chile, farm-to-table dining, craft breweries, and local wineries. The Utilization Review Case Management RN Nurse will appreciate an approachable cost of living, welcoming communities, and easy access to regional attractions that turn weekends into memorable getaways.

Compensation, benefits, and next steps The Utilization Review Case Management RN Nurse will be offered competitive compensation up to $90,000, along with a full suite of health and retirement benefits that may include medical, dental, vision, HSA/FSA options, paid time off, tuition assistance, licensure and certification support, and retirement plan matching. The Utilization Review Case Management RN Nurse can take the next step by connecting with a Clinical Management Consultants recruiter to explore this opportunity in confidence and learn how this role can align with long-term career goals—reach out today and turn clinical expertise into system-level impact.

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