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Online Utilization Review Jobs in Rochester, NY (NOW HIRING)

Claude Tutor

Rochester, NY ยท Remote

$18 - $40/hr

... online Claude tutors nationally. As a tutor on the Varsity Tutors Platform, you'll have the ... Ability to explain system prompts, context window utilization, and responsible AI interaction while ...

Intake Coordinator

Rochester, NY ยท On-site

$20.15 - $25.15/hr

The incumbent screens referrals, conducts assessments and Admission Safety Reviews, communicates ... Basic Computer Literacy as evidenced by the ability to go online and conduct basic searches on the ...

... review resumes for interview consideration * Collaborate with HRBP - Assurance, to identify ... Determine utilization metrics and measurements, report to the SL to hold people accountable to ...

Process Technician Diffusion

Hopewell, NY ยท On-site

$27.60 - $48.12/hr

Review Statistical Process Control charts for process quality and react to Out of Control ... utilization, and cost * Complete all required reporting and documentation * Operate computer and ...

Showing results 21-40

Online Utilization Review information

See Rochester, NY salary details

$21

$41

$68

How much do online utilization review jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for online 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 is the difference between Online Utilization Review vs Utilization Review Coordinator?

AspectOnline Utilization ReviewUtilization Review Coordinator
CredentialsTypically requires healthcare or insurance certifications, such as RN, CPC, or CCMOften requires similar certifications, with additional administrative or coordination training
Work EnvironmentRemote or office-based, reviewing patient records and insurance claims onlineOffice setting, coordinating reviews and communicating with providers and patients
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare facilities, third-party review agencies

Online Utilization Review involves assessing medical necessity and coverage remotely using digital records, while Utilization Review Coordinator manages the review process, coordinating between providers and insurers. Both roles require similar credentials and are integral to healthcare and insurance industries, but Online Utilization Review is more focused on remote case assessments, whereas the Coordinator handles administrative oversight.

How do I get into an online utilization review?

To become an online utilization review specialist, you typically need a healthcare-related degree such as nursing, health administration, or a related field, along with experience in medical coding or insurance. Certification in utilization review, such as the Certified Professional in Healthcare Quality (CPHQ), can improve job prospects. Strong analytical skills and familiarity with medical records and insurance policies are also important for this role.

What are some common challenges faced by professionals in online utilization review, and how can they be addressed?

One common challenge in Online Utilization Review is staying up-to-date with changing regulations and payer requirements, which can impact approval criteria and documentation standards. Another challenge is effectively managing a high volume of cases while maintaining accuracy and meeting turnaround times. Building strong communication skills for collaborating with providers and interdisciplinary teams is also crucial. To address these challenges, professionals often participate in ongoing training, utilize clinical decision support tools, and foster open communication with team members and stakeholders.

What is an online utilization review?

An Online Utilization Review is a process in which healthcare professionals evaluate the necessity, efficiency, and appropriateness of medical services, procedures, or hospital admissions using digital platforms. This review is typically conducted remotely, using electronic health records and online communication tools to assess patient care. The goal is to ensure that patients receive the most effective care while avoiding unnecessary treatments and controlling healthcare costs. Online Utilization Review professionals may work for hospitals, insurance companies, or third-party administrators to maintain quality standards and compliance with regulations.

What are the key skills and qualifications needed to thrive as an online utilization review specialist?

To thrive as an Online Utilization Review Specialist, you need a solid background in nursing or healthcare, with credentials such as an RN or LPN license and experience in clinical review processes. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines and medical necessity criteria are typically required. Strong analytical thinking, attention to detail, and clear written communication help you effectively assess cases and interact with healthcare providers. These skills ensure accurate case reviews, compliance with regulations, and optimal patient care while controlling healthcare costs.
What are the most commonly searched types of Utilization Review jobs in Rochester, NY? The most popular types of Utilization Review jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Online Utilization Review jobs? Cities near Rochester, NY with the most Online Utilization Review job openings:
Infographic showing various Online Utilization Review job openings in Rochester, NY as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, and 4% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.

$35 - $38/hr

Full-time, Part-time

Retirement

Re-posted 9 days ago


Job description

Description

We are Hiring!ย 

Job Posting: REGISTERED NURSE

Location: ย 146 Hobart St

Department: ย Nursing

Employment Type: ย Limited Part-Time

Schedule: ย Weekend Saturday and Sunday

Salary: ย $35 - $38/hr


General Description

Under general supervision, provides comprehensive health services and supervision for LPN and/or Medical Liaison staff if applicable. Works collaboratively with other providers to facilitate client wellness. Maintains all applicable confidentiality and ethical standards of relevant governing bodies. Effectively supports ongoing and collaborative communication amongst all program staff and is responsible for ensuring a trauma informed care environment.


Essential Duties and Responsibilities

  • Provides a comprehensive health assessment of clients.
  • Identifies immediate and long-term health care needs.
  • Makes appropriate referrals and recommendations based on findings of the health assessments.
  • Assists clients in identifying local resources.
  • Communicates and collaborates with appropriate Agency staff, Primary Health care provider, community justice agencies, and related community organizations to assure coordination of client care and services.ย 
  • Completes required paperwork related to the health assessment process.
  • Provide oversight and supervision of any assigned LPN and/or Medical Liaison Staff:
  • Required supervision of tasks performed by LPN and/or Medical Liaison staff may include medication monitoring or administration, monitoring of vital signs, reporting of signs or symptoms of potential health concerns, basic emergency medical treatment or interventions.
  • Direct, coach, collaborate with and delegate tasks appropriately.
  • Build and sustains cooperative working relationships among program staff.
  • Assist in the initiation and implementation of staff development and training programs to maximize professional practice.
  • Accesses employees' skills and program needs and appropriately assign staff to meet program needs.
  • Participates in selection, hiring, and orientation of Staff.
  • Coordinates employee schedules to ensure day-to-day coverage of the Programs.
  • Reviews and approves timesheets.
  • Evaluates program effectiveness and recommends alternatives as required.
  • Assists Prescribers
  • Provide health monitoring for clients
  • Administers Injectable medications as prescribed
  • Responsible for case load records
  • Completes required case record documentation in accordance with regulations and other record keeping as necessary for program accountability
  • Participates in monthly Utilization Review, quality assurance and program evaluation activities as directed.
  • Coordinates discharge planning for clients
  • Provides education to clients on health and wellness issues.
  • Participates in staff meetings and clinical supervision as directedย ย ย 
  • Actively pursues development of professional competencies related to job role performance through reading, supervision, in-service training and attendance at conferences and workshops.ย 
  • ย Awareness and active support of the Agency's Mission, Vision, Values and Strategic Plan. Including, but not limited to, supporting the Agency's Core Competency initiatives of being Collaborative and Community Focused, Innovative and Entrepreneurial, and Culturally Competent and Diverse

Note: The above description is illustrative of tasks and responsibilities. It is not meant to be all inclusive. Employees are required to follow appropriate supervisory direction and perform other related duties as required.

Requirements

Qualifications

Education: Minimum of an Associate's Degree in Nursing required. Bachelor's or Master's Degree in Nursing preferred.


Credentials: Valid and clean NYS Driver's License. Valid Registered Professional Nurse (RN) License required

Experience: At least two years of experience related to nursing services to individuals with mental health, chemical dependency, substance use disorder, or intellectual/developmental disabilities-related services strongly preferred. Bi-lingual in Spanish also preferred.


Physical Demands/Work Environment: The physical demands/work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit, talk, hear, stand, walk, use hands to type and/or perform light lifting. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. The noise level in the work environment is usually quiet.


Compliance: Adheres to all applicable federal and state laws and regulations including, but not limited to, those governing confidentiality, privacy, program, billing, and documentation standards. All duties must be performed in accordance with CCFCS's corporate compliance & ethics program.ย  Any offer of employment will be contingent upon successful completion of a background check. CCDOR considers all background check information in accordance with applicable law.


Additional Requirements:

  • Ability to prioritize assignments, plan, and complete work projects with minimal direction,
  • An ability to work efficiently and effectively and meet deadlines,ย 
  • An ability to work under pressure,
  • Excellent verbal/written skills,
  • Ability to maintain confidentiality,
  • Ability to demonstrate behaviors and attitudes which support agency mission, philosophy, and policies.
  • Willingness and ability to foster agency and program wide cooperation and teamwork through use of positive/constructive communication techniques,
  • Possession of a valid NYS Driver's license and use of a registered and reliable vehicle. ย 

Top Benefits and Perks:

  • Competitive salary and 403b retirement planย 
  • Generous time off package and work-life balanceย 
  • Comprehensive benefits packageย 
  • Supportive and collaborative environmentย 
  • Opportunities for growth and developmentย 
  • Intrinsic reward of truly making a difference in people's livesย 

Join us and help make a positive impact in our community!
***Catholic Charities is committed to leveraging the talent of a diverse workforce to create great opportunities for our agency and our people. EOE/AA Disability/Vetย