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Remote Utilization Management Jobs in Rochester, NY

Mvphealthcare

Concurrent Review - RN

Rochester, NY · Remote

$69K - $92K/yr

Ideal for experienced RNs looking to expand into utilization management, this position provides ... Whereyou'llbe: Location: Remote Pay Transparency MVP Health Care is committed to providing ...

IDEX

Assistant Controller

West Henrietta, NY · On-site +1

... utilization, and labor/burden studies Participate in analysis of consolidated operations/cost ... This position is a remote role; however, we are seeking candidates who reside within reasonable ...

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · Remote

... management of assigned therapists when necessary * Perform ongoing review of high-risk cases and provide clinical solutions as appropriate * Engage in the Utilization Review process for assigned ...

All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Rochester, NY

Remote Utilization Management information

See Rochester, NY salary details

$21

$41

$68

How much do remote utilization management jobs pay per hour?

As of Jul 7, 2026, the average hourly pay for remote utilization management 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.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

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

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Rochester, NY? The most popular types of Utilization Management jobs in Rochester, NY are:
What are popular job titles related to Remote Utilization Management jobs in Rochester, NY? For Remote Utilization Management jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Rochester, NY look for? The top searched job categories for Remote Utilization Management jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Remote Utilization Management jobs? Cities near Rochester, NY with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Health Insurance & Authorization Specialist II

Health Insurance & Authorization Specialist II

Highland Hospital

Rochester, NY • On-site, Remote

$20.99 - $28.34/hr

Other

Posted 17 days ago

Highland Hospital (New York) rating

7.7

Company rating: 7.7 out of 10

Based on 24 frontline employees who took The Breakroom Quiz

209th of 1,004 rated hospitals

Job description

he Health Insurance and Authorization Specialist is responsible for verifying patient insurance eligibility and coverage and securing third-party payer authorization for our urgent/emergent inpatients, observation cases, maternity, and newborn admissions and notifies Utilization Management of clinical requests during the hospital stay.  The Specialist also works closely with the uninsured/underinsured for appropriate referrals to our Financial Case Management team to assess patients for health insurance or financial assistance.  They track our Medicare patients for benefit exhaustion to ensure compliance with Medicare Life Time Reserve (LTR) consent forms and consistently exercise judgment to resolve insurance barriers on the assigned admissions to avoid billing delays.  This role involves a more significant amount of external coordination with outside agencies, including MVA/WC carriers, Motor Vehicle Accident Indemnification Corporation (MVAIC) agency, attorney offices, and works with parents to add their newborn through the NYS Marketplace or employer group.
Supervision:              Responsible for monitoring own performance on assigned tasks.  Self-directed and must make complex decisions independently.  May train other support staff.
                                   
                                    This role may have the option to work a hybrid-remote schedule and communicate daily through virtual meetings.
Salary Range:
$20.99-  $28.34 an hour
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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