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Entry Level Utilization Review Nurse Jobs in Rochester, NY

... nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff ... review and creation of desk level procedures, acting as a subject matter expert for UM Services.

Utilization Management Services Rep I

Rochester, NY · On-site

$15.75 - $21.50/hr

... nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff ... review and creation of desk level procedures, acting as a subject matter expert for UM Services.

Showing results 21-40

Entry Level Utilization Review Nurse information

See Rochester, NY salary details

$21

$41

$68

How much do entry level utilization review nurse jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for entry level utilization review nurse in Rochester, NY is $41.74, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

How to get into utilization review as an entry level utilization review nurse?

To become an entry-level utilization review nurse, candidates typically need a nursing license (RN) and relevant clinical experience. Gaining knowledge of insurance policies, medical coding, and utilization review processes through training or certification programs such as the Certified Professional in Healthcare Quality (CPHQ) can improve job prospects.

What are some common challenges faced by entry level utilization review nurses, and how can they overcome them?

Entry level Utilization Review Nurses often encounter challenges such as adapting to complex insurance policies, learning to review medical records efficiently, and communicating effectively with physicians and case managers. To overcome these challenges, new nurses should seek mentorship from experienced colleagues, participate in ongoing training sessions, and familiarize themselves with the organization's review protocols and documentation systems. Building strong communication skills and staying up to date with regulatory changes will also help in navigating the learning curve and ensuring successful case reviews.

What is the difference between Entry Level Utilization Review Nurse vs Utilization Review Nurse?

AspectEntry Level Utilization Review NurseUtilization Review Nurse
CredentialsRN license, possibly some certificationRN license, often with additional certifications
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, healthcare organizations
Job ResponsibilitiesAssist in reviewing patient cases, gather data, support senior staffEvaluate medical necessity, review patient records, make coverage decisions

The Entry Level Utilization Review Nurse typically supports the more experienced Utilization Review Nurse by gathering information and assisting in case reviews. Both roles require an RN license and work within healthcare or insurance settings, but the entry-level position involves more support tasks, while the Utilization Review Nurse makes critical coverage decisions.

What are the key skills and qualifications needed to thrive as an entry level utilization review nurse, and why are they important?

To thrive as an Entry Level Utilization Review Nurse, you need a registered nurse (RN) license, knowledge of clinical guidelines, and an understanding of healthcare regulations. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) are often beneficial. Strong analytical thinking, attention to detail, and effective communication skills help you review cases accurately and collaborate with providers. These skills ensure appropriate care decisions, compliance with payer requirements, and optimal patient outcomes.

What is an entry level utilization review nurse?

An Entry Level Utilization Review Nurse is a registered nurse (RN) who is new to the field of utilization review. Their main responsibilities include assessing medical records, ensuring that patients receive appropriate and necessary care, and verifying that health services are delivered according to established guidelines and insurance requirements. They typically work for hospitals, insurance companies, or managed care organizations and collaborate with healthcare providers to support quality patient outcomes while managing costs. This role often serves as a stepping stone to more advanced positions in healthcare administration or case management.
What are the most commonly searched types of Utilization Review Nurse jobs in Rochester, NY? The most popular types of Utilization Review Nurse jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Entry Level Utilization Review Nurse jobs? Cities near Rochester, NY with the most Entry Level Utilization Review Nurse job openings:
Infographic showing various Entry Level Utilization Review Nurse job openings in Rochester, NY as of August 2026, with employment types broken down into 88% Full Time, and 12% Part Time. Highlights an 88% In-person, and 12% Remote job distribution, with an average salary of $86,813 per year, or $41.7 per hour.

Registered Nurse (RN) Case Manager I (Full-Time, Days) - Home Care

Rochester Regional Health

Newark, NY • On-site

Other

Re-posted 26 days ago


Rochester Regional Health rating

7.3

Company rating: 7.3 out of 10

Based on 218 frontline employees who took The Breakroom Quiz

304th of 887 rated healthcare providers


Job description

RN Case Manager

The RN Case Manager is responsible for the delivery of comprehensive nursing care to a set of assigned patients at a specific point in time. This involves the assessment of patient and family needs and the development, implementation and evaluation of an appropriate Plan of Care, making changes in response to changing patient needs. The RN Case Manager identifies appropriate interdisciplinary services needed, coordinates those services and supervises Private Duty Nurses (PDN) as applicable.

STATUS: Full-Time

LOCATION: Rochester Regional Health Home Care - Newark

DEPARTMENT: HHC CHHA NE REGION NURSING

SCHEDULE: Monday-Friday, 8:00am-4:00pm

Why Join Our Team?

  • Set your own work schedule to fit your lifestyle and work-life balance
  • Mileage reimbursement + paid drive time between patient visits
  • Shift differentials to reward your flexibility
  • Overtime opportunities for additional earning potential
  • Up to $10,000 in tuition assistance for BSN to MSN advancement
  • Tuition and student loan assistance programs to support your financial goals
  • Comprehensive full benefits package

ATTRIBUTES

  • Level I - 1 year of nursing experience preferred.
  • Prior home health, clinical and direct patient care experience preferred.
  • Ability to work independently.
  • Demonstration of solid interpersonal, organizational and time management skills.
  • Proficient computer skills.
  • Must be able to document clinical notes and assessments within an electronic medical record.
  • Ability to travel to and from required locations as needed to perform the essential responsibilities of the job.
  • Level II – requires similar qualifications as level I, plus:
  • Understands when to escalate to management.

RESPONSIBILITIES

  • Identifies and prioritizes health problems based on assessment
  • Develops or implements an interdisciplinary Plan of Care based on the needs identified during the assessment, with input from the patient (and their caregivers as applicable), in collaboration with the attending physician and other care team members
  • Manages and coordinates patient care, including clinically complex cases, in a manner which ensures the efficient and effective delivery of appropriate services and community supports
  • Exhibits proficiency and accuracy in the completion of comprehensive assessment/documentation, which may include assessments required by payer sources (e.g., Outcome and Assessment Information Set (OASIS), Hospice Item Set (HIS)).
  • Plans, organizes and prioritizes care needs for an assigned caseload of patients to ensure their care needs are met and services are delivered according to plan of care
  • Communicates all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner
  • Facilitates the development and implementation of patient discharge plans as indicated
  • Documents all patient care and coordinating activities per agency standards
  • Assesses the need for additional services (aide, therapies, social work or a community service) and obtains orders and arranges care as indicated
  • Supervises and evaluates care provided by Licensed Practical Nurses and/or home health aides in the performance of his/her patient care duties
  • Works collaboratively with other care team members by communicating all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner.
  • Correctly identifies patient/family risk factors and establishes goals and interventions to reduce/remove risk from the plan of care to enable patients to remain in the least restrictive care setting.
  • Coordinate/participate in interdisciplinary team meetings/patient care conferences.
  • Patient needs are prioritized; visits outside primary team assignment or geographical area may be required in order to meet patient need.
  • Practices according to Agency and community standards
  • Participates in utilization review and/or continuous quality improvement activities as requested.
  • Attends required staff meetings, in-services and/or supervisory conferences.
  • Participates in on-call schedule and weekend/holiday schedule as assigned.
  • Consistently demonstrates high standards of integrity by supporting the Rochester Regional Health Companies' mission and values and adhering to the Corporate Code of Conduct.
  • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Regular and reliable attendance is expected and required.
  • Performs other job-related duties as assigned by management.

REQUIRED QUALIFICATIONS

  • Diploma or Associate's Degree in Nursing required
  • Registered Nurse license in New York State.
  • Valid NYS Driver's License.

PREFERRED QUALIFICATIONS

  • Bachelor's Degree in Nursing preferred.

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE:

$77,983.00 - $103,906.00

CITY:

Newark

POSTAL CODE:

14513

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.


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