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Reimbursement Case Manager Jobs in Rochester, NY

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How much do reimbursement case manager jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for reimbursement case manager in Rochester, NY is $24.42, according to ZipRecruiter salary data. Most workers in this role earn between $18.99 and $26.54 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a reimbursement case manager?

To thrive as a Reimbursement Case Manager, you need a solid understanding of healthcare reimbursement processes, insurance policies, and medical billing, often supported by a background in nursing, social work, or healthcare administration. Familiarity with claims management systems, electronic health records (EHRs), and payer portals is typically required, and certifications like CCM (Certified Case Manager) can be advantageous. Strong communication, problem-solving, and organizational skills help you effectively advocate for patients and collaborate with providers and payers. These competencies ensure accurate reimbursement, compliance, and optimal patient outcomes in a complex healthcare environment.

How does a reimbursement case manager typically collaborate with healthcare providers and insurance companies to resolve patient billing issues?

Reimbursement Case Managers act as key liaisons between healthcare providers, patients, and insurance companies to ensure that claims are processed accurately and efficiently. They regularly communicate with medical staff to collect necessary documentation, clarify coding, and verify treatment details. Additionally, they work closely with insurance representatives to address denials, appeal decisions, and troubleshoot payment delays. This collaborative approach requires strong communication skills and a deep understanding of both clinical and insurance processes.

What is the difference between Reimbursement Case Manager vs Claims Specialist?

AspectReimbursement Case ManagerClaims Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires insurance or claims processing certifications
Work EnvironmentHealthcare facilities, insurance companies, or managed care organizationsInsurance companies, third-party administrators, or healthcare providers
Job FocusManaging reimbursement processes, verifying coverage, and resolving billing issuesProcessing claims, reviewing documentation, and ensuring accurate claim submission

Reimbursement Case Managers and Claims Specialists both work within the healthcare and insurance industries, focusing on financial aspects of patient care. While Reimbursement Case Managers primarily handle reimbursement processes and coverage verification, Claims Specialists concentrate on processing and reviewing insurance claims. Both roles require knowledge of insurance policies and healthcare billing, but their daily tasks and focus areas differ slightly.

What does a reimbursement case manager do?

A reimbursement case manager reviews and processes insurance claims and reimbursement requests, ensuring accuracy and compliance with policies. They communicate with clients, healthcare providers, and insurance companies, often using case management software, to resolve issues and facilitate timely payments.

What are popular job titles related to Reimbursement Case Manager jobs in Rochester, NY?

For Reimbursement Case Manager jobs in Rochester, NY, the most frequently searched job titles are:

What job categories do people searching Reimbursement Case Manager jobs in Rochester, NY look for?

The top searched job categories for Reimbursement Case Manager jobs in Rochester, NY are:

What cities near Rochester, NY are hiring for Reimbursement Case Manager jobs?

Cities near Rochester, NY with the most Reimbursement Case Manager job openings:

Reimbursement Case Manager jobs near you
Infographic showing various Reimbursement Case Manager job openings in Rochester, NY as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 14% Part Time, and 1% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $50,821 per year, or $24.4 per hour.

Registered Nurse (RN) Case Manager, Palliative Home Care (Full-Time, Days)

Rochester Regional Health

Rochester, NY • On-site

$77K - $103K/yr

Full-time

Re-posted 26 days ago

Rochester Regional Health rating

7.3

Company rating: 7.3 out of 10

Based on 218 frontline employees who took The Breakroom Quiz

307th of 888 rated healthcare providers

Job description

Job Title: Registered Nurse Case Manager
Department:PALLIATIVE CARE NURSING - Monroe County
Location: Rochester Regional Health Home Care - Monroe Ave
Hours Per Week: 40
Schedule: Monday - Friday, 8:30am-5:00pm
Rochester Regional Health Home Care is the only home care provider in the region to earn a CMS 5-Star Quality of Patient Care rating, placing its CHHA among the top 3.5% of agencies nationwide.
In addition, CHHA was recognized by U.S. News & World Report as a "High Performing Home Care Agency," further highlighting its commitment to exceptional patient care and clinical excellence.
Why Join Our Team?
  • Set your own work schedule to fit your lifestyle and work-life balance
  • Mileage reimbursement + paid drive time between patient visits
  • Shift differentials to reward your flexibility
  • Overtime opportunities for additional earning potential
  • Up to $10,000 in tuition assistance for BSN to MSN advancement
  • Tuition and student loan assistance programs to support your financial goals
  • Comprehensive full benefits package

SUMMARY
The RN Case Manager is responsible for the delivery of comprehensive nursing care to a set of assigned patients at a specific point in time. This involves the assessment of patient and family needs and the development, implementation and evaluation of an appropriate Plan of Care, making changes in response to changing patient needs. The RN Case Manager identifies appropriate interdisciplinary services needed, coordinates those services and supervises Private Duty Nurses (PDN) as applicable.
RESPONSIBILITIES
  • Identifies and prioritizes health problems based on assessment
  • Develops or implements an interdisciplinary Plan of Care based on the needs identified during the assessment, with input from the patient (and their caregivers as applicable), in collaboration with the attending physician and other care team members
  • Manages and coordinates patient care, including clinically complex cases, in a manner which ensures the efficient and effective delivery of appropriate services and community supports
  • Exhibits proficiency and accuracy in the completion of comprehensive assessment/documentation, which may include assessments required by payer sources (e.g., Outcome and Assessment Information Set (OASIS), Hospice Item Set (HIS)).
  • Plans, organizes and prioritizes care needs for an assigned caseload of patients to ensure their care needs are met and services are delivered according to plan of care
  • Communicates all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner
  • Facilitates the development and implementation of patient discharge plans as indicated
  • Documents all patient care and coordinating activities per agency standards
  • Assesses the need for additional services (aide, therapies, social work or a community service) and obtains orders and arranges care as indicated
  • Supervises and evaluates care provided by Licensed Practical Nurses and/or home health aides in the performance of his/her patient care duties
  • Works collaboratively with other care team members by communicating all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner.
  • Correctly identifies patient/family risk factors and establishes goals and interventions to reduce/remove risk from the plan of care to enable patients to remain in the least restrictive care setting. Coordinate/participate in interdisciplinary team meetings/patient care conferences.
  • Patient needs are prioritized; visits outside primary team assignment or geographical area may be required in order to meet patient need.
  • Practices according to Agency and community standards
  • Participates in utilization review and/or continuous quality improvement activities as requested.
  • Attends required staff meetings, in-services and/or supervisory conferences.
  • Participates in on-call schedule and weekend/holiday schedule as assigned.

REQUIRED QUALIFICATIONS
  • Diploma or Associate's Degree in Nursing
  • Registered Nurse license in New York State

PREFERRED QUALIFICATIONS
  • 1 year of nursing experience
  • Prior home health, clinical and direct patient care experience

EDUCATION:
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$77,983.00 - $103,906.00
CITY:
Rochester
POSTAL CODE:
14607
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

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