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Rn Utilization Management Jobs in Rochester, NY (NOW HIRING)

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Rn Utilization Management information

See Rochester, NY salary details

$38.5K

$88.3K

$160.8K

How much do rn utilization management jobs pay per year?

As of Aug 16, 2026, the average yearly pay for rn utilization management in Rochester, NY is $88,283.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,600.00 and $103,100.00 per year, depending on experience, location, and employer.

How does an RN Utilization Management typically collaborate with physicians and other healthcare team members?

RN Utilization Management professionals work closely with physicians, case managers, and insurance representatives to ensure patients receive appropriate, high-quality care while managing healthcare costs. They review patient records, communicate clinical findings, and may participate in interdisciplinary meetings to discuss care plans and discharge needs. Building strong relationships and maintaining open lines of communication with the care team is essential for timely authorizations and effective care coordination. This collaborative approach helps optimize patient outcomes and resource utilization.

What skills and qualifications are needed to thrive as an RN Utilization Management?

To thrive as an RN Utilization Management Nurse, you need a current RN license, strong clinical assessment skills, and experience in care coordination or case management. Familiarity with utilization review tools, electronic health records, and knowledge of insurance guidelines or InterQual/MCG criteria are typically required. Exceptional communication, critical thinking, and negotiation skills help facilitate collaboration among providers, payers, and patients. These abilities are crucial for ensuring appropriate resource use, compliance with regulations, and optimal patient outcomes.

How to get into utilization management as an RN?

To become an RN in utilization management, gain experience as a registered nurse, often in case management or clinical roles, and obtain knowledge of insurance policies and healthcare regulations. Certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) can enhance prospects. Strong communication skills and familiarity with electronic health records (EHR) systems are also beneficial.

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

AspectRn Utilization ManagementRn Case Management
CertificationsRN license, possibly certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentUtilization review departments, insurance companies, hospitalsCommunity clinics, hospitals, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Both roles require an RN license, but Rn Utilization Management focuses on reviewing the necessity of services, while Rn Case Management emphasizes coordinating patient care. Understanding these differences helps professionals choose the right career path and employers.

What does a utilization management registered nurse do?

A utilization management registered nurse reviews patient cases to determine the necessity, appropriateness, and efficiency of healthcare services and treatments. They analyze medical records, collaborate with healthcare providers, and ensure compliance with insurance and regulatory guidelines, often using electronic health records and clinical judgment. Certification in case management or utilization review is commonly required for this role.

What is an RN Utilization Management?

RN Utilization Management nurses are registered nurses who specialize in reviewing healthcare services to ensure patients receive appropriate and cost-effective care. They evaluate the necessity, efficiency, and quality of medical treatments and procedures, often working with insurance companies, hospitals, or healthcare organizations. Their responsibilities include reviewing patient records, coordinating with clinical staff, making coverage recommendations, and ensuring compliance with healthcare regulations. This role helps manage healthcare costs while maintaining high standards of patient care.

What are popular job titles related to Rn Utilization Management jobs in Rochester, NY?

For Rn Utilization Management jobs in Rochester, NY, the most frequently searched job titles are:

What job categories do people searching Rn Utilization Management jobs in Rochester, NY look for?

The top searched job categories for Rn Utilization Management jobs in Rochester, NY are:

Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in Rochester, NY as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $88,283 per year, or $42.4 per hour.

Registered Nurse (RN) - General Surgery

Rochester Regional Health

Rochester, NY • On-site

$38.67 - $51.92/hr

Other

Re-posted 17 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 887 rated healthcare providers

Job description

Job Title: Registered Nurse I-V

Department: General Surgery (2800)

Location: Rochester General Hospital

Hours Per Week: 36 Hours

Schedule: Night

SUMMARY:

As a Registered Nurse (RN), you’re the engine and the heart of patient care at Rochester Regional Health. You make a positive

difference every single day in the lives of our patients, their family members and visitors – going above and beyond to meet

their needs with courtesy, kindness, respect and compassion.

The General Surgical Unit (2800) cares for pre and post-surgical patients including general, colorectal, plastics and breast, bariatrics, urology, ENT and neurosurgery. This fast-paced unit is a great fit for experienced and new RNs who enjoy multidisciplinary teamwork and rewarding patient interactions.

CLINICAL LADDER LEVEL I-IV

The RN level will be determined at the time of hire based on the candidate’s qualifications and ability to meet Clinical Ladder requirements. An established compensation add-on is applied to each RN level.

Level expectations include:

RN Level II: Minimum 6 months RN experience; AAS in Nursing; completion of Clinical Ladder requirements within 12 months, including 3 activities per pillar (Leadership, Quality, Organizational Contribution), 9 CEUs, and 6 flex items.

RN Level III: Minimum 1 year RN experience; AAS in Nursing; demonstrated clinical and leadership skills; preceptor and/or charge experience; completion of 4 activities per pillar, 12 CEUs, and 15 flex items.

RN Level IV: Minimum 1 year experience in the specialty hired into; BS in Nursing required; expanded leadership role (charge, preceptor, mentor); completion of Clinical Ladder requirements within 12 months, including 5 activities per pillar, 15 CEUs, and 20 flex items.

RESPONSIBILITIES:

  • Provides high-quality, patient-centered, clinical care

  • Performs initial and ongoing assessment of the patient, utilizing appropriate data (i.e. physical, psychological, educational and risk-screen data appropriate for the chronological / developmental age of the patient).

  • Communicates and documents assessment of patient with the interdisciplinary team. Utilizes all available resources in order to meet the needs of the patient and family.

  • Develops and documents plan of care, treatment and services which is individualized and appropriate for the patient needs, strengths, limitations and goals.

  • Complies with organizational policies, procedures and protocols including policies governing safety, medication administration and documentation.

  • Revises plan of care based on ongoing evaluations and updates documentation appropriately.

  • Completes at least one clinical research utilization (CRU) form for submission to Nursing Research Department utilizing a research article from the last 5 years from research performed in the United States.

COMPLIANCE:

  • Completes a minimum of 5 nationally approved contact hours (CNE or CEU) per year.

  • Completes mandatory in-services and health screens in timely manner.

  • Maintains Basic Life Support (BLS) certification.

REQUIRED QUALIFICATIONS:

  • Diploma or Associate’s Degree in Nursing

  • Registered Nurse license in New York State.

  • Basic Life Support (BLS) certification.

PREFERRED QUALIFICATIONS:

  • Bachelor’s Degree in Nursing preferred.

  • At least 6 months RN experience preferred

EDUCATION:

AS: Nursing (Required)

LICENSES / CERTIFICATIONS: 

BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department (NYSED)New York State Education Department (NYSED)

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:

$38.67 - $51.92

CITY:

Rochester

POSTAL CODE:

14621

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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