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Manager Utilization Management Jobs in Rochester, NY

Lthc

Utilization Management Services Rep I

Rochester, NY

$15.75 - $21.50/hr

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers ...

Lthc

Utilization Management Services Rep I

Rochester, NY

$15.75 - $21.50/hr

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers ...

Highland Hospital

RN Case Manager PC/FM

Rochester, NY · On-site

$37 - $45/hr

... utilization management, proactive patient management, care facilitation and treatment planning functions. The RN Care Manager manages clinical aspects of patient centered medical home, working with ...

Deloitte

Epic Tapestry Specialist

Rochester, NY · On-site +1

Work Experience/Direct knowledge of Utilization Management or Tapestry Utilization Management build * Ability to work independently and collaborate as part of a team * Effective written and verbal ...

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All JobsManager Utilization Management JobsManager Utilization Management Jobs in Rochester, NY

Manager Utilization Management information

See Rochester, NY salary details

$38.5K

$89.8K

$165.3K

How much do manager utilization management jobs pay per year?

As of Jun 20, 2026, the average yearly pay for manager utilization management in Rochester, NY is $89,798.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $108,000.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a Manager in Utilization Management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a Manager of Utilization Management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Rochester, NY? The most popular types of Utilization Management jobs in Rochester, NY are:
What are popular job titles related to Manager Utilization Management jobs in Rochester, NY? For Manager Utilization Management jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Rochester, NY look for? The top searched job categories for Manager Utilization Management jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Manager Utilization Management jobs? Cities near Rochester, NY with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Rochester, NY as of June 2026, with employment types broken down into 1% As Needed, 96% Full Time, 1% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $89,798 per year, or $43.2 per hour.

Utilization Management RN

UR Thompson Health

Canandaigua, NY • On-site

$35 - $47/hr

Full-time

Posted 17 days ago

Job description

Schedule: Full-time days- Monday through Friday with shared rotating weekends.
Fully in person position
Do you want to work in a culture where interdisciplinary teams come together to improve care, where your suggestions are welcomed and your ideas are part of the solution? Explore the Thompson difference and apply today!
UR Medicine's Thompson Health is the premier healthcare provider in the Finger Lakes region. You will enjoy a competitive salary and generous benefits, free onsite parking, an excellent staffing model and a modern, caring, high-tech environment.
Internal Title: Utilization Management / CDS Nurse ( RN )
UM/CDS Nurse Responsibilities:
  • Perform extensive record review in accordance with state regulations, ensuring compliance with changes affecting Utilization Management and Clinical Documentation Improvement.
  • Assess the appropriateness and medical necessity of treatment requests on a prospective, concurrent, and retrospective basis.
  • Collaborate with providers to determine appropriate admission status and potential changes using critical thinking skills and recognized criteria.
  • Interact frequently with providers, HIM professionals, Social Workers, nursing staff, patients/patients' caregivers, and insurance companies.
  • Review medical records to improve clinical documentation, representing the severity of illness, risk of mortality, and patient complexity.

Description:
  • Perform utilization review in accordance with state regulations, ensuring compliance with changes affecting Utilization Management
  • Collaborate with providers to determine appropriate admission status and potential changes.
  • Assess the appropriateness and medical necessity of treatment requests for utilization review on a prospective, concurrent, and retrospective basis.
  • Review patient records and evaluate progress, obtaining necessary medical reports and treatment plan requests.
  • Review medical records to improve the quality of clinical documentation, representing the severity of illness, risk of mortality, and patient complexity.
  • Provide review information to payers as requested.
  • Perform retroactive reviews for assigned denials and monitor steps throughout the denial process.
  • Write effective appeal letters and inform appropriate departments of outcomes.
  • Work with Medical Staff, Case Management/Social Work, Clinical Quality, and interdisciplinary care team to ensure quality patient outcomes through appropriate utilization of hospital resources.
  • Collect, analyze, and maintain data on the utilization of medical services and resources to identify trends and opportunities for improvement.
  • Serve as primary contact for Utilization Management related issues, both internally and externally.
  • Assess quality and clinical risk issues on a concurrent basis, reporting quality of care issues as identified.
  • Provide education to medical staff, department leaders, medical offices, and associates on Utilization Management principles, including the use of InterQual & Milliman criteria and CMS regulations.
  • Actively participate in committees and workgroups related to Utilization Management, Length of Stay Management, Readmissions and Observation services.
  • Collaborate and assist the manager in executing a Quality and Safety model, integrating regulatory mandates, and providing training for JC readiness.
  • Participate in team meetings and staff education in the Utilization Management process and Clinical Documentation Improvement Program.

Required Competencies:
  • Demonstrated Knowledge or willingness to learn: Utilization Management principles including knowledge of various regulatory and payer specific requirements.
  • Clinical Knowledge: Proficiency in clinical criteria and understanding of medical treatments and interventions.
  • Critical Thinking: Ability to assess the appropriateness and medical necessity of treatment requests.
  • Regulatory Awareness: Knowledge of state and federal regulations guiding the authorization, denial, and appeal processes.
  • Communication Skills: Effective interaction with providers, HIM professionals, Social Workers, nursing staff, patients, caregivers, and insurance companies.
  • Documentation Skills: Accurate and thorough documentation to support clinical decisions and ensure compliance.
  • Analytical Skills: Ability to collect, analyze, and maintain data on the utilization of medical services and resources.
  • Demonstrate attention to detail in all aspects of documentation and review processes.
  • Prioritize tasks effectively to manage multiple responsibilities and deadlines.
  • Adapt to changing situations and regulatory requirements in the healthcare environment.
  • Patient Advocacy: Ensuring patients receive appropriate and cost-effective healthcare services.
  • Collaboration: Working effectively with interdisciplinary teams to ensure quality patient outcomes.
  • Adaptability: Staying up to date with changes in healthcare regulations and best practices.
  • Lives the CARES values at all times.

Requirements:
Registered Nurse in NYS
Education:
  • A.A.S. in Nursing
  • B.S. in Nursing or other Health related field or willingness to get one within 5 years of employment.

Experience:
  • Minimum 5 years of acute nursing experience.
  • Prefer Utilization Review or Clinical Documentation Specialist experience.
  • Experience working with physicians in a collaborative supportive manner.
  • Knowledgeable in the use of nationally recognized criteria or willingness to learn.
  • Knowledgeable in reimbursement methodologies & interpretation of payer contracts or willingness to learn.
  • Experience with computer applications including Microsoft Office.
  • Preferred experience with Epic.
  • Preferred experience in writing effective appeal letters.

Complexity of Duties:
  • Performs a variety of duties requiring independent judgment and decision-making and adjusting priorities as needed.
  • Keeps abreast of complex and changing regulatory environment.
  • Handle difficult situations with providers, patients and caregivers, using strong communication skills to diffuse situations and reach resolution.
  • Effectively manage denials / appeals with attention to detail and follow-up.
  • Competently issues Notices of Status Change, MOONs and HINNs/ABNs when appropriate.

*** Shared weekends
Position Pay Range: $35.00-47.00/hour
Starting Pay: Based on experience
Thompson Health is an EOE encouraging individuals with disabilities and veterans to apply
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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