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Remote Utilization Management Nurse Jobs in Rochester, NY

Director of Operations

Rochester, NY · Remote

$85K - $135K/yr

This is a remote position with a residency requirement of Rochester, New York. The ideal candidate ... Manage and communicate with healthcare facilities, offering complaint resolution and high-level ...

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Remote Utilization Management Nurse information

See Rochester, NY salary details

$21

$41

$68

How much do remote utilization management nurse jobs pay per hour?

As of Jul 19, 2026, the average hourly pay for remote utilization management nurse 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 Remote Utilization Management Nurse vs Remote Case Manager?

AspectRemote Utilization Management NurseRemote Case Manager
CredentialsRN license, certifications like CCM or ANCCRN license, certifications like CCM or similar
Work EnvironmentHealthcare organizations, insurance companies, telehealthInsurance companies, healthcare providers, telehealth
Job FocusReviewing medical necessity, authorizations, and utilizationCoordinating patient care, discharge planning, resource management

Both roles require RN licensure and similar certifications, often working remotely within healthcare or insurance settings. The main difference lies in focus: Utilization Management Nurses primarily review medical necessity and authorization requests, while Case Managers coordinate patient care and discharge planning. Understanding these distinctions helps job seekers identify the role that best matches their skills and career goals.

What is a Remote Utilization Management Nurse?

A Remote Utilization Management Nurse is a registered nurse who works from a remote location, such as their home, to review patient medical records and determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. Their main responsibilities include reviewing clinical documentation, conducting pre-authorization reviews, and ensuring compliance with healthcare regulations and insurance guidelines.

What Does a Remote Utilization Management Nurse Do?

As a remote utilization management nurse, you work from home to perform a variety of duties and responsibilities, such as corresponding with and interviewing physicians, modifying patient treatment plans, analyzing investigation information, and auditing patient records. As a UM nurse, you may also deal with other clinical tasks, referrals, authorizations, and reviews. You usually work for insurance companies and healthcare providers to help to determine if patients should receive authorization for needed treatments or for those that they already receive. In some cases, you may monitor processes to ensure that hospital patients are getting what they need during their stay.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

To thrive as a Remote Utilization Management Nurse, you need a valid RN license, clinical experience (often in acute care), and a solid understanding of utilization review and healthcare regulations. Familiarity with case management software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Strong analytical skills, attention to detail, and effective written and verbal communication are essential soft skills for successful remote collaboration and decision-making. These skills ensure accurate assessments, compliance with standards, and the delivery of cost-effective, quality patient care from a remote setting.

What are some common challenges faced by Remote Utilization Management Nurses, and how can they be addressed?

Remote Utilization Management Nurses often face challenges such as maintaining effective communication with interdisciplinary teams, staying updated on changing insurance guidelines, and managing a high volume of case reviews. To address these issues, it's helpful to establish regular virtual check-ins with team members, utilize digital tools for efficient documentation, and participate in ongoing training on payer requirements. Developing strong organizational skills and proactively seeking clarification on complex cases can also contribute to success in this role.
What are the most commonly searched types of Utilization Management Nurse jobs in Rochester, NY? The most popular types of Utilization Management Nurse jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Remote Utilization Management Nurse jobs? Cities near Rochester, NY with the most Remote Utilization Management Nurse job openings:

Hematology Business Manager - Rochester, NY

PharmaEssentia U.S.A.

Rochester, NY • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 2 days ago


Job description

About PharmaEssentia:
It's not often you get the chance to make a real impact on the lives of others, while expanding your own possibilities. You'll find that rare opportunity at PharmaEssentia. Join us, and let's transform lives, together.
PharmaEssentia Corporation is a rapidly growing biopharmaceutical innovator. We are leveraging deep expertise and proven scientific principles to deliver effective new biologics for challenging diseases in the areas of hematology and oncology, with one product approved and a diversifying pipeline. We believe in the potential to improve both health and quality of life for patients with limited options today through the combination of rigorous research and innovative thinking. Founded in 2003 by a team of Taiwanese-American executives and renowned scientists from U.S. biotechnology and pharmaceutical companies, today we are listed on the Taiwan Stock Exchange (TWSE: 6446) and are expanding our global presence with operations in the U.S., Japan, Singapore, South Korea, and China, along with a world-class biologics production facility in Taichung.
Position Overview:
PharmaEssentia is seeking an experienced Hematology Account Manager with a strong patient focus and a passion for driving results for its commercial product, BESREMi®. This position is responsible for all sales activities in an assigned geographical area and will be expected to maximize sales achievement through promotion of PharmaEssentia products to approved, targeted customers and distribution channels. You will build and execute strategic territory plans across stakeholders involved in patient care in order to educate customers about BESREMi® and address the various needs along the treatment adoption process. Customers include hematologists/oncologists, nurses, pharmacists, pharmacy and therapeutics groups, teaching institutions, hospitals and formulary committees.
Key Responsibilities:
Customer Focus
  • Communicate the clinical profile of BESREMi®, describe pivotal trial data and address clinical and non-clinical barriers in a clear and impactful manner to key customers involved in hematology oncology patient care
  • Partnering with cross-functional commercial partners such as market access and medical teams to provide comprehensive solutions for customers
  • Contribute to a culture of continuous learning and going the extra mile for patients by sharing knowledge across teams, investing in personal skill development, and striving to keep abreast of changing clinical and business dynamics
Results Focus
  • Build, maintain and apply clinical and business expertise within the hematology oncology marketplace to develop territory business plans designed to address the needs of various customers within the geography as it relates to BESREMi®
  • Developing specific account/prescriber action plans that provide a clear line-of-site to achieving established goals within a specific timeframe, using analytics to understand trends and track progress against goals
  • Meet and exceed business objectives through thoughtful planning, collaboration with partners and utilization of tools and resources for flawless execution of strategic direction
Entrepreneurial Expertise
  • Becoming a true subject matter expert on all key topics that impact the success of the business - disease state knowledge, clinical acumen, product expertise, competitive intelligence, market dynamics, customer needs across segments, local market access, etc.
  • Being a creative, resourceful problem solver with a "no job is too big or too small" attitude that is essential for success in a startup environment
  • Growing one's knowledge and capabilities (clinical, marketplace, competitive), trying new approaches to persistent challenges, continually raising the bar on performance
Business Acumen
  • Using data and sound judgement to continually evaluate plans and make changes as necessary to course correct and address evolving landscape and business dynamics
  • Utilizing CRM as a strategic tool for assessing and tracking customer status and progressing sales plans
  • Completing of sales administrative requirements (T&E, compliance SOPs, Sunshine reporting, etc.)
Qualifications and Experience:
  • 5+ years of experience within the pharmaceutical or biotechnology industries including experience in the hematology, solid tumor, or rare disease space
  • Bachelor's degree required
  • A consistent track record of hematology oncology sales experience in academic and community-based institutions
  • Existing relationships with key customers are highly valued (e.g., KOLs, key account leadership)
  • Experience in new product launches is required
  • Experience in and understanding of other commercial functions (e.g., marketing, market access, sales operations, sales training, insights/analytics, business development, etc.) is preferred
  • Experience working in a start-up company environment is preferred
  • Specialty pharmacy knowledge is preferred
  • Track record of performance and a passion for making a difference for patients
  • Ability to understand all facets of the sales cycle including patient identification, building clinical conviction, understanding and overcoming access and reimbursement barriers, and navigating distribution
  • Ability to think creatively and seek solutions to access customers and support business needs
  • Excellent interpersonal, oral and written communication skills and a strong leadership presence
  • Demonstrated ability to adapt to changes in the work environment. Able to maintain a big picture view in the face of frequent change, delays, unexpected events, or uncertainty/ambiguity involved in new product launches with maturity and professionalism
  • Must consistently act with high ethical standards and always keep the patient at the forefront
  • Strong critical thinking and strategic problem-solving skills
  • Demonstrates a strong sales hunter mentality. Able to develop new leads and drive for results
  • Advanced business acumen and granular account acumen management skills
  • Successful experience covering large geographical territories autonomously
The expected base salary range for this position is $180,000 to $200,000. Salary offers are based on a wide range of factors including relevant skills, training, experience, education and geographical location. Market and organizational factors are also considered. In addition to base salary and a competitive benefits package, successful candidates are eligible for short-term and long-term incentives.
Benefits of working with our team:
PharmaEssentia USA strives every day to improve the lives of patients as well as our employees. As a valued member of PharmaEssentia USA, you will enjoy the following benefits:
  • Comprehensive medical coverage
  • Dental and vision coverage
  • Generous paid time-off
  • 401(k) retirement plan with competitive company match
  • Medical & Dependent Care Flexible Spending Account
  • Monthly cell phone reimbursement
  • Employee Assistance Program

EEO Statement:
At PharmaEssentia USA, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. PharmaEssentia USA believes that diversity and inclusion among our team are critical to our success as a global company, and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.
PharmaEssentia does not accept unsolicited agency resumes. Staffing agencies should not send resumes to our HR team or to any PharmaEssentia employees. PharmaEssentia is not responsible for any fees related to unsolicited resumes from staffing agencies.
At PharmaEssentia, our goal is to treat as many people with cancer as possible. That means challenging the status quo with better science that leads to better lives. By joining our team, you will not only expand your own possibilities, but you will contribute to expanding options for people with cancer.
https://us.pharmaessentia.com/careers/