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Insurance Utilization Review Jobs in New York (NOW HIRING)

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How much do insurance utilization review jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for insurance utilization review in New York is $46.26, according to ZipRecruiter salary data. Most workers in this role earn between $36.54 and $53.12 per hour, depending on experience, location, and employer.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in insurance utilization review?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the most commonly searched types of Insurance Utilization Review jobs in New York?

The most popular types of Insurance Utilization Review jobs in New York are:

What are popular job titles related to Insurance Utilization Review jobs in New York?

For Insurance Utilization Review jobs in New York, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in New York look for?

The top searched job categories for Insurance Utilization Review jobs in New York are:

What cities in New York are hiring for Insurance Utilization Review jobs?

Cities in New York with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in New York as of August 2026, with employment types broken down into 92% Full Time, and 8% Contract. Highlights an 100% In-person job distribution, with an average salary of $96,216 per year, or $46.3 per hour.

Utilization Management Registered Nurse

St. Joseph's Health

Paterson, NJ • On-site

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 8 days ago

St. Joseph's Health (New Jersey) rating

7.7

Company rating: 7.7 out of 10

Based on 47 frontline employees who took The Breakroom Quiz

157th of 887 rated healthcare providers

Job description


The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role. The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization. The role is responsible for the assessment of medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimizes risks of denials.
Qualifications
Work requires the knowledge of theories, principles, and concepts normally acquired through completion of a Bachelor of Science in Nursing and least at least 3 years of previous nursing experience. Preferred 3+ years of Utilization Review or Case Management experience. Case Management Society of America Certification CCM preferred. Licensure required as a Registered Nurse by the State of New Jersey.
About Us
St. Joseph's Health is recognized for the expertise and compassion of its highly skilled and responsive staff. The combined efforts of the organization's outstanding physicians, superb nurses, and dedicated clinical and professional staff have made us one of the most highly respected healthcare organizations in the state, the largest employer in Passaic County, and one of the nation's "100 Best Places to Work in Health Care".
Benefits Eligibility: (Full-time and Part-time Employees-over 20 hours a week)
  • Competitive salary*
  • Robust benefits with health, dental, Rx and vision plans
  • 403b retirement plan options with company match**
  • Health & Wellness*
  • Non-Profit Health System - eligible for Federal Student Loan Forgiveness
  • PTO, and paid holidays
  • Tuition reimbursement
  • Employee Assistance Program
  • LTD : Long Term Disability
  • Life Insurance Options
  • Onsite Day care Program

*Available for Per Diem Employees and Part-time Employees working under 20 hours per week.
**403b Company Match not applicable for Per Diem Employees and Part-time Employees working under 20 hours per week.
Pay transparency: St. Joseph's Health provides a salary range to comply with New Jersey Law. The rate of pay for each position will be determined based on a variety of factors including the candidate's relevant experience, qualifications, skills, etc." The salary range does not include incentives, differential pay or other forms of compensation.
About the Team
St. Joseph's University Medical Center is an academic tertiary care medical center and state designated trauma center, located on the Paterson campus, regularly accepts referrals of difficult or unusual cases from other hospitals and physicians and performs both complex and routine procedures.
The Medical Center offers a full complement of specialty and subspecialty services including ambulatory, behavioral health, cardiovascular, emergency/trauma, internal medicine, neuroscience, oncology, orthopedic/spine, rehabilitation, surgical specialty, women's health, imaging and pediatrics.
The nursing team at St. Joseph's University Medical Center, which includes St. Joseph's Children's Hospital, has held the Magnet Award for Nursing Excellence, the profession's highest honor, since 1999. They are also recipients of the prestigious 2010 Magnet Prize™ - one of only 8 Magnet-designated hospitals to ever receive The Magnet Prize, and the only one worldwide to receive the 2010 award.

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