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Remote Utilization Management Nurse Jobs in Rochester, NY

... management of assigned therapists when necessary * Perform ongoing review of high-risk cases and ... Engage in the Utilization Review process for assigned cases every month * Respond to clinical ...

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Remote Utilization Management Nurse information

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$41

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

As of Sep 5, 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 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?

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 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 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:

Infographic showing various Remote Utilization Management Nurse job openings in Rochester, NY as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.

Licensed Clinical Social Worker - Full-time Remote Opportunity at Addiction Health Center

Addiction Health Center

Rochester, NY โ€ข Remote

$90K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 17 days ago


Job description

Position Overview

We are seeking a dedicated and compassionate Licensed Clinical Social Worker (LCSW) to join our team at the Addiction Health Center, located in Rochester, New York. This full-time remote position offers an excellent opportunity to provide critical mental health support while working in a team-oriented, nurturing environment.

About the Organization

The Addiction Health Center specializes in delivering comprehensive and exceptional mental health support tailored to a broad spectrum of patient needs. Our team is composed of skilled professionals committed to fostering a safe space for healing and personal development. We pride ourselves on our inclusive approach to mental health, ensuring that every voice within our community is heard and valued.

Work Environment

This role is primarily remote, which allows for flexibility and comfort while performing your duties. While the Addiction Health Center operates within a structured framework, we encourage teamwork and open communication among staff members. Youโ€™ll collaborate with colleagues via virtual platforms to discuss patient care strategies and ensure alignment on treatment protocols.

Key Responsibilities
  • Act as a liaison between families and outpatient providers, facilitating effective communication to support patient care.
  • Engage with insurance companies for essential pre-certification processes and to manage utilization effectively.
  • Participate in comprehensive discharge and aftercare planning to ensure continuity of care and support for each client post-treatment.
  • Provide therapeutic meal support, guiding clients towards developing a healthy relationship with food in a respectful and affirming manner.
  • Offer empathetic and culturally competent care, tailored to meet the unique needs of clients based on their intersecting identities, to foster an inclusive environment that promotes healing.
Patient Population / Client Focus

Our focus is primarily on clients struggling with addiction and mental health issues, including older adults who face unique challenges in these areas. We recognize the diverse backgrounds and experiences of our clients, allowing for tailored approaches in therapeutic interventions that acknowledge and respect their histories.

Qualifications
  • A Masterโ€™s degree in Social Work from an accredited institution is required.
  • Possession of a valid LCSW license in the state of New York is essential.
  • Experience working with older adults is highly preferred.
  • Strong clinical and diagnostic skills are crucial for this position.
  • Candidate must exhibit excellent communication and interpersonal skills to effectively interact with clients, colleagues, and external partners.
  • Ability to work independently as well as collaboratively within a team setting.
Preferred Experience

While the required qualifications focus on licensing and degree, preferred experience includes strong background in behavioral health settings, particularly those catering to addiction recovery and support services. Familiarity with electronic health record (EHR) systems and management of client care documentation will enhance your capability in this role.

Compensation and Benefits

The compensation for this position ranges from $90,000 to $105,000 per year, commensurate with experience and qualifications. In addition to competitive pay, we offer a comprehensive benefits package which includes medical, dental, and vision insurance plans to maintain your well-being. Additional benefits include a 401(k) retirement plan with company matching, flexible spending accounts, life insurance, and short-term disability coverage for enhanced financial security.

Career Growth Opportunities

At the Addiction Health Center, we believe in investing in our employees' futures. We offer opportunities for professional development and continuing education, which support your growth within our organization. You will also be encouraged to take on leadership roles and contribute to best practices in the field of social work, collaborating with diverse teams on innovative projects.

Why Join Our Team

Joining the Addiction Health Center allows you to become part of a mission-driven organization dedicated to making a positive impact in the lives of our clients. By delivering compassionate, evidence-based care, you will help clients on their journey towards recovery and empowerment. If you are passionate about social work and want to be part of a supportive network that values your contributions, we encourage you to apply.

Application Information

If you are interested in taking the next step in your career and making a difference, please submit your application today. We look forward to welcoming a dedicated and talented Licensed Clinical Social Worker to our compassionate team at the Addiction Health Center.