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Insurance Utilization Review Jobs in New York (NOW HIRING)

GQR

RN - Case Manager

Mount Vernon, NY · On-site

$2.8K - $2.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mount Vernon ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

GQR

RN - Case Manager

Bronx, NY · On-site

$3.0K - $3.1K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: West Bronx ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

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Insurance Utilization Review information

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$46

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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.

Associate Medical Director, Utilization Management

Oscar Health

New York, NY • Remote

$240K - $315K/yr

Full-time

Re-posted 14 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

255th of 306 rated insurance

Job description

Hi, we're Oscar. We're hiring an Associate Medical Director to join our Utilization Management Team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

This role determines the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This role also influences departmental strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards.

You will report into the Senior Medical Director.

Work Location: This is a remote position, open to candidates holding an active medical license in Florida, Arizona or North Carolina, OR to physicians who hold an IMLC compact license. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $240,120 - $315,157 annually. You are also eligible for employee benefits including a performance bonus, 401K with immediate vesting, and unlimited PTO.

Responsibilities:

  • Provide timely medical reviews that meet Oscar's stringent quality parameters.

  • Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.

  • Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).

  • Use correct templates for documenting decisions during case review.

  • Receive and review escalated reviews.

  • Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.

  • Manage direct reports and oversee their performance.

  • Provide oversight to ensure the team meets turn-around times for clinical reviews.

  • Collaborate with other departments on Utilization Management Operations.

  • Lead key projects and drive initiatives to successful completion.

  • Other duties as assigned

  • Compliance with all applicable laws and regulations.ocus on the main or important responsibilities))

Requirements:

  • Board certification as an MD or DO with a current unrestricted license to practice medicine is required.

  • 3+ years of clinical practice

  • 2+ years of utilization review experience in a managed care plan (health care industry)

Bonus points:

  • Licensure in multiple Oscar states

  • Experience with care management within the health insurance industry.

  • Willing and able to obtain additional state licensure as business needs, with Oscar's support

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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