... 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 ...
Sous Chef
$25/hr
... utilization of leftover foodstuffs. 3. Assists with estimating food consumption amounts and determining type and quantity of meats, vegetables and other foods to be prepared. 4. Reviews menus and ...
Sous Chef
$25/hr
... utilization of leftover foodstuffs. 3. Assists with estimating food consumption amounts and determining type and quantity of meats, vegetables and other foods to be prepared. 4. Reviews menus and ...
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 31, 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.
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 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.
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
- Remote Lpn Utilization Review
- Optum Utilization Review Nurse
- Coumadin Clinic Registered Nurse
- Remote Utilization Review Nurse Practitioner
- Remote Navihealth Utilization Review
- Internship Rn Utilization Review Nurse
- From Home Anthem Utilization Review Nurse
- No Experience Rn Clinical Data Abstractor
- Remote Preservice 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:
RN Case Manager - UR Nurse
Fairport, NY
Healthcare Support Staffing •
Recruiting and Staffing Services • 201 - 500 employees201 - 500 employees
Full-time
Re-posted 14 days ago
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