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Full Time Optum Utilization Review Jobs in Rochester, NY

Acacia Network

Program Director

Rochester, NY · On-site

$85K/yr

Perform utilization reviews, monitoring case records, ensuring compliance with all contract ... At Least five years of full-time work experience in Substance Use Disorder or related treatment ...

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All JobsOptum Utilization Review JobsFull Time Optum Utilization Review JobsFull Time Optum Utilization Review Jobs in Rochester, NY

Full Time Optum Utilization Review information

See Rochester, NY salary details

$21

$41

$68

How much do full time optum utilization review jobs pay per hour?

As of Jul 31, 2026, the average hourly pay for full time optum utilization review in Rochester, NY is $41.72, 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.

What are some common challenges faced by Full Time Optum Utilization Review nurses, and how can they be managed?

Full Time Optum Utilization Review nurses often encounter challenges such as managing high caseloads, staying updated with frequently changing insurance and regulatory guidelines, and effectively communicating with both healthcare providers and patients. Time management and strong organizational skills are crucial for balancing documentation with timely case reviews. Collaborating closely with multidisciplinary teams and utilizing technology tools provided by Optum can help streamline workflows and ensure compliance with policies, ultimately leading to more effective patient care coordination.

What are the key skills and qualifications needed to thrive as a Full Time Optum Utilization Review Nurse, and why are they important?

To thrive as a Full Time Optum Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and platforms like InterQual or MCG is typically required. Excellent communication, critical thinking, and attention to detail are vital soft skills for effectively coordinating care and collaborating with providers. These abilities ensure efficient, compliant care management, cost containment, and optimal patient outcomes within the healthcare system.

What is a Full Time Optum Utilization Review position?

A Full Time Optum Utilization Review position involves working for Optum, a healthcare services company, to review patient medical records and determine the medical necessity and appropriateness of healthcare services. Utilization Review professionals collaborate with healthcare providers, insurers, and patients to ensure that care provided is efficient, cost-effective, and aligns with established guidelines. The role typically requires knowledge of clinical standards, strong communication skills, and the ability to interpret medical documentation. Full-time positions often come with benefits and require standard weekly work hours.

What is the difference between Full Time Optum Utilization Review vs Full Time Medical Reviewer?

AspectFull Time Optum Utilization ReviewFull Time Medical Reviewer
CertificationsTypically requires medical licenses and utilization review certificationsRequires medical licenses, often with additional certifications in utilization review
Work EnvironmentInsurance companies, healthcare organizations, remote or office-basedHospitals, clinics, insurance companies, often in clinical settings
Employer & Industry UsagePrimarily in health insurance and managed careIn healthcare facilities and insurance sectors

Full Time Optum Utilization Review professionals focus on evaluating medical necessity for insurance claims, often working remotely or in insurance settings. Full Time Medical Reviewers also assess medical necessity but may work directly within clinical environments. Both roles require medical credentials and involve reviewing patient records, but their work settings and employer types differ slightly.

What are the most commonly searched types of Optum Utilization Review jobs in Rochester, NY? The most popular types of Optum Utilization Review jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Full Time Optum Utilization Review jobs? Cities near Rochester, NY with the most Full Time Optum Utilization Review job openings:
Full Time Optum Utilization Review jobs near you

UR Cardiac Care Flex Team - Registered Nurse 2, Inpatient

University of Rochester

Rochester, NY • On-site

$40.03 - $54.04/hr

Full-time

Re-posted 6 days ago

University Of Rochester rating

8.3

Company rating: 8.3 out of 10

Based on 186 frontline employees who took The Breakroom Quiz

123rd of 614 rated colleges and universities

Job description

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
Job Location (Full Address):
220 Hutchison Rd, Rochester, New York, United States of America, 14620
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
500424 Heart Flex Team/Nrsg-SMH
Work Shift:
Range:
UR URCG 215 H
Compensation Range:
$40.03 - $54.04
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Responsibilities:
The Level II Registered Nurse, under the direction of the Nurse Manager, is accountable for provision of competent direct patient care based on established standards. The Level II Registered Nurse contributes to unit activities and supports enhancement of the care delivery system at the unit level. The Level II Registered Nurse supports peers in the delivery of patient care services and assumes an expanded role which may include charge nurse, preceptor, and committee member responsibilities.
Schedule
FT, PT and Per Diem positions available. D/E/N weekends and holidays as required. Straight Night and Evening shifts available.
Responsibilities
Unique offering to explore the rewarding nursing care of cardiac patients throughout our Cardiac Care service line with opportunity for professional growth as well as advanced clinical skill building. Patient populations include the continuum of pre-procedural to post-surgical care of patients with varied cardiovascular and thoracic disease states including advanced heart failure and mechanical circulatory support. Flex team members generally complete an eight week assignment on one of our units. Successful candidates will demonstrate flexibility, critical thinking, excellent communication and organizational skills and willingness to work in variable settings and teams. Orientation to the units and new populations are provided. One year of adult med surg or cardiac experience required. ICU experience is a plus. Opportunities for clinical advancement are supported and encouraged. Ask about the potential options for special scheduling arrangements.
Qualifications
Requires a Diploma, Associate or Bachelor's degree from an accredited Nursing Program and an active New York State RN license in good standing. Applicants will have a minimum of 6-12 months of RN experience. This position assumes the charge nurse role, actively participates in unit/service activities, supports co-workers, and assesses unit needs.
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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