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Utilization Management Associate Jobs in New York

MJHS

Managed Care Coordinator

Manhattan, NY · On-site

$38K - $48K/yr

Our MJHS Medical Associates, P.C. is a group of Nurse Practitioners, Physician Assistants, RN Case ... Familiarity with utilization management/case management

Actuary Company

Associate Chief Medical Officer

Newark, NJ · Remote

$269K - $374K/yr

... utilization management, clinical development of medical cost reduction initiatives, collaboration ... The Associate CMO oversees a team of clinicians (physicians, nurses and others) and non-clinicians ...

Pride Health

Utilization Review Nurse

Queens, NY · On-site

$2.5K - $2.8K/wk

Associate's Degree in Nursing from an accredited educational institute. Required Certifications ... management, or patient advocacy activities. * Strong knowledge of medical, nursing, behavioral ...

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Utilization Management Associate information

What does a utilization management associate do?

A Utilization Management Associate is responsible for reviewing healthcare services and determining whether they are medically necessary, appropriate, and efficient. They work with healthcare providers, insurance companies, and patients to ensure that treatments comply with established guidelines and policies. Their role often includes reviewing medical records, processing authorizations, and assisting in the coordination of care to optimize the use of healthcare resources. This position helps control costs while ensuring that patients receive the appropriate level of care.

What skills and qualifications are needed to thrive as a utilization management associate?

A Utilization Management Associate typically needs a background in healthcare administration or a related field, strong analytical skills, and knowledge of medical terminology and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and regulatory compliance systems is important, and certifications like Certified Professional in Healthcare Management (CPHM) can be advantageous. Attention to detail, effective communication, and strong organizational skills help associates excel in evaluating medical necessity and collaborating with care teams. These competencies ensure accurate, efficient review processes that support quality patient care and compliance with payer requirements.

What are the typical daily responsibilities of a utilization management associate?

Utilization Management Associates typically review medical records, verify insurance coverage, and coordinate with healthcare providers to ensure that treatments and services meet established guidelines and payer requirements. They also communicate with physicians and patients to gather necessary information for authorization requests. By ensuring appropriate utilization of healthcare resources, they help support patient care while managing costs and compliance for their organization. Collaboration with clinical staff and insurance representatives is a key part of the role, contributing to effective case management.

What is the difference between Utilization Management Associate vs Utilization Review Coordinator?

AspectUtilization Management AssociateUtilization Review Coordinator
CertificationsTypically requires a healthcare-related certification or licenseOften requires similar certifications, such as CCM or RHIA
Work EnvironmentWorks in insurance companies, healthcare providers, or managed care organizationsWorks in hospitals, insurance companies, or healthcare facilities
Job FocusAssists in reviewing medical necessity and authorization processesCoordinates and conducts utilization reviews and approvals
Common UsageUsed interchangeably in healthcare and insurance settingsOften used in hospital and insurance contexts

The Utilization Management Associate and Utilization Review Coordinator roles share similarities in certifications and work environments, focusing on reviewing medical necessity and authorization. The main difference lies in their specific responsibilities, with associates assisting in the process and coordinators actively conducting reviews and approvals.

What are the most commonly searched types of Utilization Management jobs in New York?

The most popular types of Utilization Management jobs in New York are:

What cities in New York are hiring for Utilization Management Associate jobs?

Cities in New York with the most Utilization Management Associate job openings:

Infographic showing various Utilization Management Associate job openings in New York as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, and 2% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution.

Administrative Manager Medical Management (JR229819)

Mount Vernon, NY • On-site

Montefiore Mount Vernon
See more jobs at Montefiore Mount Vernonexternal

Full-time

Re-posted 28 days ago

Key responsibilities

  • Manage the Department's operations and activities, including discharge planning, utilization management, transition of care, and high-risk case management.

  • Provide strategic and operational leadership for care management services, including Case Management, Social Work, and Care Transitions.

  • Lead, mentor, and develop the care management team, fostering a collaborative and accountable culture.

Job description

IntroductionTo heal, to teach, to discover and to advance the health of the communities we serve.

To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here. 

OverviewEnsure that patients receive quality care in the most cost-effective manner and at the appropriate level. Manage the Department's operations and activities, including discharge planning, utilization management, transition of care, and high-risk case management. Provides strategic and operational leadership for care management services, including Case Management, Social Work, and Care Transitions. Ensures optimum utilization of Social Work and RN Case Management Skills. Collaborate across departments to align care coordination with organizational goals, especially Length of Stay (LOS) optimization and discharge efficiency. Responsible for achieving and promoting continuous quality improvement, optimal financial productivity, patient satisfaction, and other objectives identified by the Leadership Team. In collaboration with the Senior Director, this position is responsible for staff performance, establishing policies and procedures governing the program's operations, and achieving goals in accordance with all State and Federal Guidelines.

Responsibilities

  • Provides direct management to Staff. Develops program philosophy and operational goals consistent with the Organization’s Mission and Strategic Plan.
  • Ensures program compliance with Joint Commission, State, and Federal Regulations related to Discharge Planning, Utilization Management, Transition of Care, and Continuum of Care.
  • Creates and fosters positive customer relationships with patients, interdisciplinary teams, healthcare agencies, and the Network.
  • Supports effective Customer Service Networks in collaboration with the team. Identifies growth opportunities.
  • Develops and implements new services and/or programs. Interfaces and coordinates services with Admission, Finance, Managed Care, Medical Records, Home Care, Rehabilitative, and Risk Management.
  • Ensures provisions of a seamless continuum of care.
  • Ensure consistency in workflows, documentation, and discharge planning practices.
  • Support appropriate level of care decisions (e.g., admission, observation, home-based care).

Team Leadership and Development:
  • Collaborate with the Senior Director to lead, mentor, and develop high a high-performing care management team.
  • Promote professional development and succession planning across the care management structure.
  • Foster a collaborative, inclusive, and accountable culture.
  • Establishes and coordinates communication with all Utilization Regulatory Agencies.
  • Oversees appeals, at the first level of appeal as appropriate, to maximize reimbursement.
  • Reviews and edits Managed Care Contract Language relating to Utilization Management Issues.
  • Fulfills all compliance responsibilities related to the position. Ensure compliance with CMS, Joint Commission, and all relevant regulatory requirements.

Requirements

  • Bachelor’s degree in nursing and a minimum of five years of job-related experience. A Master's degree in nursing or health management is desired but not required. MSW considered.
  • Knowledge of community resources, agencies, and financial assistance programs, knowledge and/or experience in managed care.
  • Ability to collaborate with multidisciplinary groups and staff at all levels, including community partners.
  • Must possess comprehensive knowledge of the healthcare Industry, familiarity with government regulations, and possession of strategic planning skills.

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