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Utilization Care Manager Jobs in Rochester, NY (NOW HIRING)

RN Care Manager

Rochester, NY · On-site

$37 - $45/hr

Under general direction of the Clinical Manager, the RN Care Manager's central role integrates and coordinates access and utilization management, proactive patient management, care facilitation and ...

Care Manager-RN

Irondequoit, NY · On-site

$82K - $113K/yr

Three (3) years of acute hospital care, case management or utilization management experience preferred * Excellent oral and written communication and interpersonal skills * Good understanding of ...

Care Manager-RN

Rochester, NY · On-site

$82K - $113K/yr

Three (3) years of acute hospital care, case management or utilization management experience preferred * Excellent oral and written communication and interpersonal skills * Good understanding of ...

RN Case Manager PC/FM

Rochester, NY · On-site

$37 - $45/hr

Under general direction of the Clinical Manager, the RN Care Manager's central role integrates and coordinates access and utilization management, proactive patient management, care facilitation and ...

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Utilization Care Manager information

See Rochester, NY salary details

$38.5K

$89.8K

$165.3K

How much do utilization care manager jobs pay per year?

As of Aug 18, 2026, the average yearly pay for utilization care manager in Rochester, NY is $89,798.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $108,000.00 per year, depending on experience, location, and employer.

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

What cities near Rochester, NY are hiring for Utilization Care Manager jobs?

Cities near Rochester, NY with the most Utilization Care Manager job openings:

Full-time

Re-posted 26 days ago


Job description

Company Description

Throughout its history, three values - work, wellness, and independence - have remained at the core of Rochester Rehabilitation. Working with a $7 million annual operating budget, the agency serves 2,500 people in the Greater Rochester area living with disabilities, behavioral health issues, and other disadvantages.

Job Description

To provide patient-centered, high quality care management services in a timely manner to clients with complex chronic conditions by navigating systems such as primary medical, specialty and behavioral health care, as well as social services.

Key Functions:

  • Provides comprehensive care management services including: outreach and engagement; assessment/reassessment; development and implementation of initial and revised individualized care plans; consult with primary care physician, and other care provide(s); identify crisis intervention plan.
  • Provides care coordination and health promotion including: collaborate with service providers and health plans to obtain medically necessary care, share crisis intervention(s) and emergency info; linkage to services to support care and treatment goals/plans; patient education ; self-help recovery and selfmanagement; case reviews; advocate for services and assist with scheduling;collaborate with providers to ensure service delivery; monitor, support, accompany (as indicated) patient to/with scheduled appointments; crisis intervention .
  • Provides comprehensive transitional care including: follow up on notice of ER/hospital/residential/rehab setting admission and discharge; facilitate discharge planning with ER/hospital/residential/rehab setting staff to a safe location with care needs in place; notify service providers of admission/discharge and follow appointment needs; link with community supports; post discharge follow up.
  • Provides members and family support including: care planning with patient/family; patient/family consultation and education around health care needs; patient/family meetings; patient/family referral to peer supports, support groups, social services and other programs as indicated; collaborate with community providers to support service utilization based on patient/family need.
  • Provides referral to community and social support services including: identifying and linking to community supports as needed; assure and assist with access to medical, behavioral health, substance abuse and other community based services as needed.
  • Timely and comprehensive completion of documentation including notes, assessments, tracking tools, etc.
  • Adheres to Company policies and procedures to include being aware of the importance of Corporate Compliance Policies and the Code of Conduct. Staff is responsible for maintaining required certifications and licenses.
  • Attends necessary trainings and inservices, participates in department and agency meetings as required.
  • Performs other related duties as assigned by supervisor/director.
Qualifications
  • Bachelor's degree in any of the following: child & family studies, community mental health, counseling, education, nursing, occupational therapy, physical therapy, psychology, recreation, recreational therapy, rehabilitation, social work, sociology, or speech and hearing; OR
  • NYS licensure and current registration as a Registered Nurse and a bachelor's degree; OR
  • A Bachelor's level education or higher in any field with five years of experience working directly with persons with behavioral health diagnoses; OR
  • A Credentialed Alcoholism and Substance Abuse Counselor (CASAC).
  • Two years' experience (a Master's degree in a related field may substitute for one year's experience) either:
  • Providing direct services to persons with serious mental illness, developmental disabilities, alcohol or substance abuse; OR
  • Linking persons who have serious mental illness, developmental disabilities, alcohol or substance abuse.
Additional Information

To apply, please complete an online application at the link below:

https://www.rochesterrehab.org/jobseekers

Our Agencies do not discriminate against employees or applicants in the hiring, promotion, compensation, placement, termination, layoff, recall, transfer, leaves of absence or any other term or condition of employment on the basis of race, color, religion, sex, sexual orientation, gender identity/expression, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran, domestic violence victim status, prior arrest and conviction records or any other protected category in accordance with applicable federal, state and local laws.