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

Highland Hospital

RN Case Manager PC/FM

Rochester, NY

$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 ...

Highland Hospital

RN Care Coordinator

Rochester, NY · On-site

$77K - $93K/yr

... Case Manager's role is to coordinate interdisciplinary care planning to achieve timely and safe discharge and/or to coordinate access and utilization management, proactive patient management, care ...

Lthc

Medical Director, Commercial

Rochester, NY

Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical services ...

Lthc

Medical Director, Commercial

Rochester, NY

Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical services ...

Lthc

Medical Director, Commercial

Rochester, NY

Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical services ...

Mvphealthcare

Clinical Appeals RN

Rochester, NY · Hybrid

You will collaborate closely with Medical Directors, Utilization Management, and Case Management teams to support informed decision-making and ensure alignment with organizational policies and ...

DePaul

Rehabilitation & Standards Manager

Rochester, NY · On-site

$25 - $26.20/hr

Oversee systems to ensure staff provide case management / rehabilitation services to residents ... Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other ...

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How much do utilization case manager jobs pay per hour?

As of Jun 10, 2026, the average hourly pay for utilization case manager in Rochester, NY is $36.00, according to ZipRecruiter salary data. Most workers in this role earn between $29.18 and $37.93 per hour, depending on experience, location, and employer.

What is a Utilization Case Manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a Utilization Case Manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Rochester, NY? For Utilization Case Manager jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Rochester, NY look for? The top searched job categories for Utilization Case Manager jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Utilization Case Manager jobs? Cities near Rochester, NY with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Registered Nurse (RN) Case Manager I (Full-Time, Days) - Home Care

Registered Nurse (RN) Case Manager I (Full-Time, Days) - Home Care

Rochester Regional Health

Newark, NY • On-site

Full-time

Posted 26 days ago

Rochester Regional Health rating

7.4

Company rating: 7.4 out of 10

Based on 212 frontline employees who took The Breakroom Quiz

251st of 870 rated healthcare providers

Job description

SUMMARY
The RN Case Manager is responsible for the delivery of comprehensive nursing care to a set of assigned patients at a specific point in time. This involves the assessment of patient and family needs and the development, implementation and evaluation of an appropriate Plan of Care, making changes in response to changing patient needs. The RN Case Manager identifies appropriate interdisciplinary services needed, coordinates those services and supervises Private Duty Nurses (PDN) as applicable.
STATUS: Full-Time
LOCATION: Rochester Regional Health Home Care - Newark
DEPARTMENT: Homecare
SCHEDULE: Monday-Friday, 8:00am-4:30pm
Why Join Our Team?
  • Set your own work schedule to fit your lifestyle and work-life balance
  • Mileage reimbursement + paid drive time between patient visits
  • Shift differentials to reward your flexibility
  • Overtime opportunities for additional earning potential
  • Up to $10,000 in tuition assistance for BSN to MSN advancement
  • Tuition and student loan assistance programs to support your financial goals
  • Comprehensive full benefits package

ATTRIBUTES
  • Level I -1 year of nursing experienced preferred.
  • Prior home health, clinical and direct patient care experience preferred.
  • Ability to work independently.
  • Demonstration of solid interpersonal, organizational and time management skills.
  • Proficient computer skills.
  • Must be able to document clinical notes and assessments within an electronic medical record.
  • Ability to travel to and from required locations as needed to perform the essential responsibilities of the job.
  • Level II - requires similar qualifications as level I, plus:
  • Understands when to escalate to management.

RESPONSIBILITIES
  • Identifies and prioritizes health problems based on assessment
  • Develops or implements an interdisciplinary Plan of Care based on the needs identified during the assessment, with input from the patient (and their caregivers as applicable), in collaboration with the attending physician and other care team members
  • Manages and coordinates patient care, including clinically complex cases, in a manner which ensures the efficient and effective delivery of appropriate services and community supports
  • Exhibits proficiency and accuracy in the completion of comprehensive assessment/documentation, which may include assessments required by payer sources (e.g., Outcome and Assessment Information Set (OASIS), Hospice Item Set (HIS)).
  • Plans, organizes and prioritizes care needs for an assigned caseload of patients to ensure their care needs are met and services are delivered according to plan of care
  • Communicates all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner
  • Facilitates the development and implementation of patient discharge plans as indicated
  • Documents all patient care and coordinating activities per agency standards
  • Assesses the need for additional services (aide, therapies, social work or a community service) and obtains orders and arranges care as indicated
  • Supervises and evaluates care provided by Licensed Practical Nurses and/or home health aides in the performance of his/her patient care duties
  • Works collaboratively with other care team members by communicating all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner.
  • Correctly identifies patient/family risk factors and establishes goals and interventions to reduce/remove risk from the plan of care to enable patients to remain in the least restrictive care setting.
  • Coordinate/participate in interdisciplinary team meetings/patient care conferences.
  • Patient needs are prioritized; visits outside primary team assignment or geographical area may be required in order to meet patient need.
  • Practices according to Agency and community standards
  • Participates in utilization review and/or continuous quality improvement activities as requested.
  • Attends required staff meetings, in-services and/or supervisory conferences.
  • Participates in on-call schedule and weekend/holiday schedule as assigned.
  • Consistently demonstrates high standards of integrity by supporting the Rochester Regional Health Companies' mission and values and adhering to the Corporate Code of Conduct.
  • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Regular and reliable attendance is expected and required.
  • Performs other job-related duties as assigned by management.

REQUIRED QUALIFICATIONS
  • Diploma or Associate's Degree in Nursing required
  • Registered Nurse license in New York State.
  • Valid NYS Driver's License.

PREFERRED QUALIFICATIONS
  • Bachelor's Degree in Nursing preferred.

EDUCATION:
LICENSES / CERTIFICATIONS:
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:
$77,983.00 - $103,906.00
CITY:
Newark
POSTAL CODE:
14513
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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