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Insurance Utilization Review Jobs in Rochester, NY

DePaul

Rehabilitation & Standards Manager

Rochester, NY · On-site

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Rehabilitation & Standards Manager

Rochester, NY · On-site

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Rehabilitation & Standards Manager

Rochester, NY

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Operations Manager

Rochester, NY · On-site

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Operations Manager

Rochester, NY · On-site

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Operations Manager

Rochester, NY · On-site

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

DePaul

Quality Management Specialist I

Rochester, NY

$23.20 - $24.70/hr

Responsible for Utilization Record Review functions to include Individual record audits, admission ... Medical Insurance, Dental Insurance, Vision Insurance, Life Insurance, Generous PTO & Paid Holidays ...

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Insurance Utilization Review information

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How much do insurance utilization review jobs pay per hour?

As of Jul 7, 2026, the average hourly pay for insurance 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 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 the Insurance Utilization Review position, and why are they important?

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 job?

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 Rochester, NY? The most popular types of Insurance Utilization Review jobs in Rochester, NY are:
What are popular job titles related to Insurance Utilization Review jobs in Rochester, NY? For Insurance Utilization Review jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Rochester, NY look for? The top searched job categories for Insurance Utilization Review jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Insurance Utilization Review jobs? Cities near Rochester, NY with the most Insurance Utilization Review job openings:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Rochester, NY as of July 2026, with employment types broken down into 1% As Needed, 72% Full Time, 23% Part Time, and 4% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.
Utilization Review Clinician (RN)

Utilization Review Clinician (RN)

Molina Healthcare

Rochester, NY • On-site

$26.41 - $61.79/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

143rd of 277 rated insurance

Job description

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 

Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
Processes requests within required timelines. 
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
Requests additional information from members or providers as needed. 
Makes appropriate referrals to other clinical programs. 
Collaborates with multidisciplinary teams to promote the Molina care model. 
Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 

At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Ability to prioritize and manage multiple deadlines. 
Excellent organizational, problem-solving and critical-thinking skills. 
Strong written and verbal communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 

Certified Professional in Healthcare Management (CPHM). 
Recent hospital experience in an intensive care unit (ICU) or emergency room. 


To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $61.79 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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