... utilization mgt, prior authorization, concurrent review, great with Excel and someone who can ... Critical care, ICU, cardiac, neonatal, pediatric, Case Mgt, etc) * Processing 10-15 authorizations ...
... utilization mgt, prior authorization, concurrent review, great with Excel and someone who can ... Critical care, ICU, cardiac, neonatal, pediatric, Case Mgt, etc) * Processing 10-15 authorizations ...
Participate in business reviews and team huddlestoassess progress andidentifyopportunities ... Activity metrics (e.g. customer reach, frequency), progress on Good Selling Outcomes, utilization ...
Participate in business reviews and team huddlestoassess progress andidentifyopportunities ... Activity metrics (e.g. customer reach, frequency), progress on Good Selling Outcomes, utilization ...
Participate in business reviews and team huddlestoassess progress andidentifyopportunities ... Activity metrics (e.g. customer reach, frequency), progress on Good Selling Outcomes, utilization ...
Participate in business reviews and team huddlestoassess progress andidentifyopportunities ... Activity metrics (e.g. customer reach, frequency), progress on Good Selling Outcomes, utilization ...
Medical Director Occupational Medicine - Part Time
Farmington, NY · On-site
$130K - $165K/yr
Promotes effective utilization of resources to maximize departmental function and performance ... Training in pediatric, primary care or preventative care. * CME coursework related to physician ...
Medical Director Occupational Medicine - Part Time
Farmington, NY · On-site
$130K - $165K/yr
Promotes effective utilization of resources to maximize departmental function and performance ... Training in pediatric, primary care or preventative care. * CME coursework related to physician ...
Medical Director Occupational Medicine - Part Time
Farmington, NY · On-site
$130K - $165K/yr
Promotes effective utilization of resources to maximize departmental function and performance ... Training in pediatric, primary care or preventative care. * CME coursework related to physician ...
Medical Director Occupational Medicine - Part Time
Farmington, NY · On-site
$130K - $165K/yr
Promotes effective utilization of resources to maximize departmental function and performance ... Training in pediatric, primary care or preventative care. * CME coursework related to physician ...
Identify and address barriers to contract execution and utilization, providing actionable feedback ... Participate in business reviews and team huddles to assess progress and identify opportunities
Identify and address barriers to contract execution and utilization, providing actionable feedback ... Participate in business reviews and team huddles to assess progress and identify opportunities
Identify and address barriers to contract execution and utilization, providing actionable feedback ... Participate in business reviews and team huddles to assess progress and identify opportunities
Identify and address barriers to contract execution and utilization, providing actionable feedback ... Participate in business reviews and team huddles to assess progress and identify opportunities
Identify and address barriers to contract execution and utilization, providing actionable feedback ... Participate in business reviews and team huddles to assess progress and identify opportunities
Identify and address barriers to contract execution and utilization, providing actionable feedback ... Participate in business reviews and team huddles to assess progress and identify opportunities
Pediatric Utilization Review information
See Rochester, NY salary details
$21.11 - $25.38
2% of jobs
$25.38 - $29.65
9% of jobs
$32.57 is the 25th percentile. Wages below this are outliers.
$29.65 - $33.92
21% of jobs
The median wage is $37.37 / hr.
$33.92 - $38.19
23% of jobs
$38.19 - $42.46
13% of jobs
$45.78 is the 75th percentile. Wages above this are outliers.
$42.46 - $46.72
10% of jobs
$46.72 - $50.99
8% of jobs
$50.99 - $55.26
5% of jobs
$55.26 - $59.53
5% of jobs
$59.53 - $63.80
2% of jobs
$63.80 - $68.07
2% of jobs
$21
$41
$68
How much do pediatric utilization review jobs pay per hour?
As of Aug 2, 2026, the average hourly pay for pediatric 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.
Can you become a utilization reviewer without being a nurse?
Pediatric utilization review roles typically require a nursing background or healthcare-related experience, as they involve assessing medical necessity and reviewing patient care. While some positions may accept other healthcare professionals with relevant training or certifications, most employers prefer candidates with nursing credentials or clinical experience. Knowledge of medical coding, insurance policies, and utilization review software is also beneficial.
What are some common challenges faced by pediatric utilization review professionals, and how are they addressed?
Pediatric utilization review professionals often encounter challenges such as balancing the need for cost-effective care with advocating for the unique clinical needs of children. They must navigate complex insurance guidelines while collaborating closely with physicians, case managers, and families to ensure children receive appropriate and timely care. Staying updated on evolving pediatric treatment protocols and regulatory requirements is also essential. Strong communication skills and a thorough understanding of pediatric standards help address these challenges and promote positive patient outcomes.
How to become a utilization review specialist?
To become a utilization review specialist, typically one needs a relevant healthcare background such as nursing, health administration, or a related field, along with experience in medical coding or insurance. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or a similar credential can enhance job prospects, and strong analytical and communication skills are essential for reviewing medical necessity and treatment plans.
What is the highest paid pediatric job?
In pediatric healthcare, pediatric specialists such as pediatric cardiologists, pediatric intensivists, and pediatric surgeons tend to have the highest salaries. Pediatric utilization review roles generally offer competitive pay, but specialized physicians in pediatric subspecialties typically earn the highest compensation within pediatric jobs.
What are alternative careers with a pediatric background?
With a pediatric background, alternative careers include pediatric nurse, child life specialist, pediatric social worker, pediatric physical or occupational therapist, and pediatric healthcare administrator. These roles often require relevant certifications, clinical experience, and knowledge of child development and healthcare policies.
What is pediatric utilization review?
Pediatric utilization review is a process in healthcare where specialists assess the necessity, appropriateness, and efficiency of medical services provided to children. The goal is to ensure that pediatric patients receive the right care at the right time, while avoiding unnecessary treatments or procedures. Utilization review professionals review medical records, treatment plans, and insurance information to make informed decisions about coverage and care. This process helps control healthcare costs and maintain high standards of care for young patients.
What are the key skills and qualifications needed to thrive as a Pediatric Utilization Review nurse, and why are they important?
To excel as a Pediatric Utilization Review nurse, you need a solid clinical background in pediatrics, a current RN license, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and industry certifications like Certified Case Manager (CCM) are often required. Strong analytical skills, attention to detail, and effective communication help you collaborate with healthcare teams and advocate for appropriate care. These competencies ensure that pediatric patients receive necessary, cost-effective treatment while maintaining compliance with regulatory standards.
What is the difference between Pediatric Utilization Review vs Pediatric Case Manager?
| Aspect | Pediatric Utilization Review | Pediatric Case Manager |
|---|---|---|
| Credentials | Typically requires nursing or healthcare-related certifications | Requires nursing, social work, or healthcare certifications |
| Work Environment | Reviewing medical records and insurance claims, often remotely or in office | Direct patient interaction, coordinating care, often in clinical or community settings |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, clinics, community health agencies |
While both roles focus on pediatric healthcare, Pediatric Utilization Review primarily involves evaluating medical necessity and insurance claims, whereas Pediatric Case Managers coordinate ongoing patient care and support families directly. Understanding these differences helps in choosing the right career path or job search focus.
What are popular job titles related to Pediatric Utilization Review jobs in Rochester, NY? For Pediatric Utilization Review jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Pediatric Utilization Review jobs in Rochester, NY look for? The top searched job categories for Pediatric Utilization Review jobs in Rochester, NY are:
- Regional Admissions
- Optum Utilization Review Nurse
- Coumadin Clinic Registered Nurse
- Nurse Law
- Full Time Remote Lpn Utilization Review
- Full Time Anthem Utilization Review Nurse
- Volunteer Navihealth Utilization Review
- Full Time Cigna Utilization Review Nurse
- Temporary Aetna Utilization Review Nurse
- Volunteer Aetna Utilization Review Nurse
What cities near Rochester, NY are hiring for Pediatric Utilization Review jobs? Cities near Rochester, NY with the most Pediatric Utilization Review job openings:
Job description
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
- Perform review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
- Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
- Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care
- Conduct discharge planning
- Educate providers on utilization and medical management processes
- Provide clinical knowledge and act as a clinical resource to non-clinical team staff
- Enter and maintain pertinent clinical information in various medical management systems
Qualifications
- Looking for nurses with 2 years RN exp in acute care with some utilization mgt, prior authorization, concurrent review, great with Excel and someone who can Multitask (e.g. on the phone while using multiple monitors)
- Will look at nurses from Home Health, doctor office or Hospice who have processed authorizations
- Previous exp using TruCare system
- Strong Excel exp
- Background in diverse populations/environments (e.g. Critical care, ICU, cardiac, neonatal, pediatric, Case Mgt, etc)
- Processing 10-15 authorizations a day
Additional Information
Interested in hearing more about this great opportunity? Please click Apply or call Ashley Greene at 407-478-0332 Ext. 169
About Healthcare Support
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003