Insurance Utilization Review Jobs in Rochester, NY

Salary $23.00 - $26.00/hr

Employment Full Time, 40 hours per week, Monday through Friday

Purpose:

Under the direction of the Director of Mental Health, the Senior Care Manager oversees and supervises the delivery of the care management services in the program.

Key Functions:

• Provides comprehensive care management services including: outreach and Imparts agency philosophy of “Equal Opportunity, Independence and Realization of Individual Potential” to children, families, program staff and community resources.
• Maintains confidentiality of information relating to individuals and their families in accordance with agency policy.
• Adheres to agency’s policies and procedures as well as department guidelines. This includes being aware of the importance of Corporate Compliance policies and the Code of Conduct. Staff is responsible for maintaining required certifications and licenses.
• Oversees the supervision of care managers to implement and monitor standards of care.
• Conducts meetings to communicate expectations/changes in policies/procedures.
• Attends internal and outside meetings as necessary to identify service requirements or network with other providers.
• Participate in conferences, workshops and in-service training as needed or recommended to enhance job skills and personal growth and development.
• Responsible for assisting direct reports in successful accomplishment of identified key functions and goals by providing needed resources, leadership and coaching.
• Provides comprehensive care management services including: outreach and engagement; assessment/reassessment; development and implementation of initial and revised individualized care plans.
• Consult with primary care physician, and other care provider (s); identify crisis intervention plan.
• Provides care coordination and health promotion including: collaborate with service providers and health plans to obtain medically necessary care, share crisis intervention (s) and emergency info; linkage to services to support care and treatment goals/plans; patient education; self-help recovery and self-management; case reviews; advocates for services and assists with scheduling; collaborate with providers to ensure service delivery; monitor, support, accompany (as indicated) patient to/with scheduled appointments; crisis intervention.
• Provides comprehensive transitional care including: follow up on notice of ER/hospital/residential/rehab setting admission and discharge; facilitates discharge planning with ER/hospital/residential/rehab setting staff to a safe location with care needed in place; notify service providers of admission/discharge and follow-up appointments needs; link with community supports; post discharge follow- up.
• Provide member and family support including: care planning with patient/family; patient/family consultation and education around health care needs; patient/family meetings; patient/family referral to peer supports, support groups, social service s and other programs as indicated; collaborate with community providers to support services utilization based on patient/family need.
• Provide referral to community and social support services including: identifying and linking to community supports as needed; assure and assist with access to medical, behavioral health, substance abuse and other community-based services as needed.

Education, Experience, Skills and/or Licensing/Certification Required:

A Bachelor’s Degree in Human Services and 2 years of experience in public/community or community mental health settings serving low income and culturally diverse populations. Computer literacy required. Valid New York State driver’s license with approved driving record and access to a reliable vehicle with proof of insurance for vehicle is required.

Supervisory Responsibility:

Supervises care managers in the care management program

Values: Demonstrates the organization’s values

• Customer Service
• Communications
• Continuous Improvement
• Collaboration/Teamwork
• Accountability

What we offer:

• Affordable Medical / Dental / Vision Insurance
• Paid Time Off (PTO)
• 9 Paid Holidays
• Matching 403B Retirement Plan
• Additional Insurance Offerings - Specified Disease Insurance w/ Cancer Rider, Accident Insurance, Identity Theft Protection
• Employer Paid Health Reimbursement Arrangement (HRA)
• Employer paid Life Insurance, Short-term and Long-term Disability Insurance
• Tuition Reimbursement

Apply: www.rochesterrehab.org/jobseeker

Interested internal applicants are invited to submit an internal application form to Sandra Creamer, Human Resources Generalist, Rochester Rehabilitation.

Closing Date: until filled Posted 11/21/25

The agencies are equal opportunity employers. We do not discriminate against employees or applicants in the hiring, promotion, compensation, placement, termination, layoff, recall, transfer, leaves of absence or any other term or condition of employment on the basis of race, color, religion, sex, sexual orientation, gender identity/expression, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran, domestic violence victim status, prior arrest and conviction records or any other protected category in accordance with applicable federal, state and local laws.