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Pediatric Utilization Management Jobs in Rochester, NY

Highland Hospital

RN Care Manager

Rochester, NY · On-site

$37 - $45/hr

... utilization management, proactive patient management, care facilitation and treatment planning ... Outpatient primary care and/or pediatric (if applicable) experience preferred. Progressive clinical ...

Highland Hospital

RN Case Manager PC/FM

Rochester, NY · On-site

$37 - $45/hr

... utilization management, proactive patient management, care facilitation and treatment planning ... Outpatient primary care and/or pediatric (if applicable) experience preferred. Progressive clinical ...

Mercy Flight Central Inc

FLIGHT NURSE

Canandaigua, NY · On-site

$30 - $32/hr

Participation in company Quality Management program * 100% attendance at company meetings * 100 ... Utilization of Medical control for deviations of MFC Standards of Care. * Provide information ...

Mercy Flight Central Inc

FLIGHT NURSE

Canandaigua, NY

$30 - $32/hr

Participation in company Quality Management program * 100% attendance at company meetings * 100 ... Utilization of Medical control for deviations of MFC Standards of Care. * Provide information ...

Mercy Flight Central Inc.

FLIGHT NURSE

Canandaigua, NY · On-site

Participation in company Quality Management program * 100% attendance at company meetings * 100 ... Utilization of Medical control for deviations of MFC Standards of Care. * Provide information ...

Mercy Flight Central

FLIGHT NURSE

Canandaigua, NY · On-site

Participation in company Quality Management program * 100% attendance at company meetings * 100 ... Utilization of Medical control for deviations of MFC Standards of Care. * Provide information ...

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Pediatric Utilization Management information

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How much do pediatric utilization management jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for pediatric utilization management 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 Pediatric Utilization Management vs Pediatric Case Management?

AspectPediatric Utilization ManagementPediatric Case Management
CredentialsRN, licensed healthcare professionals, certifications in utilization reviewRN, social worker, case management certification
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, community health settings
Employer & Industry UsageInsurance providers, managed care organizationsHospitals, outpatient clinics, social services
FocusReviewing medical necessity, approving services, optimizing resource useCoordinating care, supporting patient needs, discharge planning

While both roles involve working with pediatric patients, Pediatric Utilization Management primarily focuses on reviewing and approving healthcare services for medical necessity within insurance or managed care settings. Pediatric Case Management emphasizes coordinating ongoing patient care and support services across healthcare providers and community resources.

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

Professionals in Pediatric Utilization Management often encounter challenges such as balancing cost-effective care with the unique needs of pediatric patients, staying updated with evolving clinical guidelines, and communicating effectively with both providers and families. Navigating insurance requirements while advocating for appropriate treatments requires strong clinical knowledge and negotiation skills. Building collaborative relationships with multidisciplinary teams and ongoing professional development can help address these challenges and ensure the best outcomes for young patients.

What are the key skills and qualifications needed to thrive as a pediatric utilization management nurse, and why are they important?

To thrive in Pediatric Utilization Management, you need a solid background in pediatric nursing, critical thinking, and knowledge of healthcare regulations, generally supported by an RN license and experience in pediatrics. Familiarity with utilization review software, electronic medical records (EMRs), and certification such as Certified Case Manager (CCM) or Utilization Review Accreditation Commission (URAC) is often required. Excellent communication, attention to detail, and strong organizational skills are crucial for collaborating with medical teams and advocating for appropriate patient care. These competencies ensure effective care coordination, regulatory compliance, and optimal outcomes for pediatric patients.

What is pediatric utilization management?

Pediatric Utilization Management (UM) is a healthcare process that reviews and evaluates the medical necessity, efficiency, and appropriateness of healthcare services provided to children. Professionals in this field assess treatment plans, hospital stays, procedures, and medications to ensure they align with evidence-based guidelines and are truly needed for a pediatric patient's care. The goal is to optimize health outcomes for children while managing healthcare costs and resources efficiently. Pediatric UM often involves collaboration between healthcare providers, insurance companies, and families to make informed decisions about a child's medical care.

What are popular job titles related to Pediatric Utilization Management jobs in Rochester, NY?

For Pediatric Utilization Management jobs in Rochester, NY, the most frequently searched job titles are:

What job categories do people searching Pediatric Utilization Management jobs in Rochester, NY look for?

The top searched job categories for Pediatric Utilization Management jobs in Rochester, NY are:

What cities near Rochester, NY are hiring for Pediatric Utilization Management jobs?

Cities near Rochester, NY with the most Pediatric Utilization Management job openings:

Pediatric Utilization Management jobs near you

RN Care Manager

Highland Hospital of Rochester

Rochester, NY • On-site

$37 - $45/hr

Other

Re-posted 11 days ago

Job description


This position is based at Highland Family Medicine. Under general direction of the Clinical Manager, the RN Care Manager's central role integrates and coordinates access and 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 the interdisciplinary medical team in the provision of patient care. May participate in supervision of other clinical staff members.
Salary Range:
$37.00 - $45.00 an hour
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Job Requirements
Qualifications:
Education: Fulfilled the educational requirements to be a licensed RN in NYS. BSN preferred.
Experience: Three to five years of professional nursing experience. Outpatient primary care and/or pediatric (if applicable) experience preferred. Progressive clinical experience including: community health, care management, and/or disease management is preferred. Experience working as a member of a multi-disciplinary team is required. Supervisory experience is desirable. Experience in data analysis and chronic illness registries. A satisfactory equivalent of education and experience will be considered.
License/Certification Required: registered nursing license. Current CPR certification required (AHA BLS for health care providers or ARC CPR for professional health care providers). Successful completion of medication proficiency examination. driver's license and the ability to travel.
Skills: Clinical expertise as it relates to chronic disease management. Analytical. Builds effective relationships; builds trust and commitment with practice physicians, the health care team, patients, and their caregivers. Knowledge of nursing processes, health care systems, and community resources. Understanding of health care technology. Familiarity with state law on nursing care, nurse practice guidelines, and clinical policies and procedures. Knowledge of wellness/illness, growth and development, human behavior, psychosocial factors, and alternative health care treatments. Knowledge of chart/medical record documentation requirements and federal/state laws related to release of health care information. Basic proficiency with Microsoft Outlook, Word, and Excel.
Population Served:
Family Medicine Neonate through geriatric
Internal Medicine Adolescent through geriatric
OB/GYN Adolescent through geriatric

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