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Senior Rn Utilization Review Nurse 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 ... Reviews complex cases with individual providers or leader and the MVP Senior Medical Leaders.

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How much do senior rn utilization review nurse jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for senior rn utilization review 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 Senior Rn Utilization Review Nurse vs Rn Case Manager?

AspectSenior Rn Utilization Review NurseRn Case Manager
CertificationsRN license, possibly UR or case management certificationRN license, often case management certification
Work EnvironmentHospitals, insurance companies, healthcare organizationsHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and utilization of servicesCoordinating patient care and discharge planning
Common UsageUsed in insurance and healthcare review settingsUsed in patient care coordination and discharge planning

The Senior Rn Utilization Review Nurse primarily focuses on evaluating the necessity and appropriateness of healthcare services, often working within insurance companies or healthcare organizations. In contrast, Rn Case Managers concentrate on coordinating patient care, discharge planning, and ensuring smooth healthcare delivery. Both roles require RN licensure and relevant certifications, but their daily responsibilities and work environments differ slightly.

What does a Senior RN Utilization Review Nurse do?

A Senior RN Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, apply clinical guidelines, and collaborate with healthcare providers to ensure that treatments are cost-effective and meet established standards of care. Additionally, they often mentor junior staff, participate in policy development, and help optimize resource utilization within healthcare organizations. Their work supports quality patient care while managing healthcare costs.

What are some typical challenges faced by Senior RN Utilization Review Nurses when coordinating with multidisciplinary teams?

Senior RN Utilization Review Nurses often collaborate with physicians, case managers, and insurance representatives to ensure patients receive appropriate, cost-effective care. A common challenge is balancing clinical guidelines with payer requirements, which can sometimes lead to differing opinions on the necessity of certain treatments or services. Effective communication, strong negotiation skills, and up-to-date knowledge of regulatory standards are essential to navigate these situations successfully. Being proactive and maintaining strong professional relationships helps facilitate smoother approvals and promotes patient-centered care.

What are the key skills and qualifications needed to thrive as a Senior RN Utilization Review Nurse, and why are they important?

To thrive as a Senior RN Utilization Review Nurse, you need a strong clinical nursing background, active RN licensure, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and certifications like CCM (Certified Case Manager) or URAC are highly beneficial. Exceptional critical thinking, attention to detail, and effective communication skills distinguish top performers in this role. These skills ensure accurate case evaluations, compliance with regulations, and optimized patient care while controlling healthcare costs.
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Senior Rn Utilization Review Nurse jobs near you

RN - Utilization Review - Syracuse, NY - RNDS

NavitasPartners

Rochester, NY • On-site

$56.21 - $65/hr

Other

This job post has expired today. Applications are no longer accepted.

Job description

Job Title: RN - Utilization Review
Location: Syracuse, NY
Type: Contract | 14 Weeks
Shift & Schedule: Day Shift | Monday-Friday

Position Overview:
Navitas Healthcare, LLC is seeking RN - Utilization Review for an exciting Travel or Local job in Syracuse, NY.

Responsibilities

  • Perform utilization review and utilization management activities to ensure appropriate patient admissions and continued stays
  • Apply MCG and InterQual screening criteria to evaluate medical necessity and level of care
  • Review and analyze patient records to support appropriate hospital admissions and discharge planning
  • Collaborate with healthcare providers, payers, and regulatory agencies to ensure compliance with CMS guidelines and hospital policies
  • Communicate effectively with physicians, case management teams, and insurance companies regarding patient status and care decisions
  • Ensure proper documentation and compliance with hospital, state, and federal regulations
  • Identify and report cases of overutilization or underutilization of healthcare services
  • Support care coordination and assist in reducing avoidable hospital readmissions
  • Maintain confidentiality and adhere to professional nursing standards

Requirements

  • Active New York State RN License required
  • Current BLS Certification required
  • Minimum 1.5 years of recent acute care hospital experience within the last 2 years required
  • Strong understanding of Utilization Review, Utilization Management, or Case Management
  • Knowledge of CMS regulations and hospital admission criteria
  • Excellent communication and interpersonal skills

Preferred Qualifications

  • Experience with MCG or InterQual screening tools preferred
  • EPIC EMR experience preferred
  • Experience working with insurance payers and regulatory agencies preferred
  • Experience in large acute care hospitals or trauma centers preferred

For more details contact at hdavda@navitashealth.com or Call / Text at 516-862-1169.

About Navitas Healthcare, LLC: It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

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