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Utilization Management Associate Jobs in Buffalo, NY

Lthc

Pharmacy Prior Authorization Technician

Buffalo, NY · On-site

$17 - $20.50/hr

Implement formulary utilization management tools (i.e. prior authorization, quantity limits, step ... Associates degree preferred. * Pharmacy Technician certification (CPhT), LPN, Medical Assistant ...

New

Lthc

Pharmacy Prior Authorization Technician

Buffalo, NY

$17 - $20.50/hr

Implement formulary utilization management tools (i.e. prior authorization, quantity limits, step ... Associates degree preferred. * Pharmacy Technician certification (CPhT), LPN, Medical Assistant ...

New

Lthc

Pharmacy Prior Authorization Technician

Buffalo, NY

$17 - $20.50/hr

Implement formulary utilization management tools (i.e. prior authorization, quantity limits, step ... Associates degree preferred. * Pharmacy Technician certification (CPhT), LPN, Medical Assistant ...

New

Pwc

Oracle Cloud Finance - Senior Associate

Buffalo, NY

$77K - $202K/yr

As a Senior Associate, you will focus on building meaningful client connections and learning how to ... and utilization of Oracle Finance systems - Managing and maintaining Oracle Finance systems to ...

Ingrammicro

Platform Transformation Manager

Buffalo, NY · On-site

$141K/yr

Drive adoption and effective utilization of Ingram Micro Xvantage, CRM, IDA, Zendesk, and other ... Coach associates and management on how to leverage platform capabilities to achieve business ...

Ingram Micro

Platform Transformation Manager

Buffalo, NY · On-site

$141K/yr

Drive adoption and effective utilization of Ingram Micro Xvantage, CRM, IDA, Zendesk, and other ... Coach associates and management on how to leverage platform capabilities to achieve business ...

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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 Buffalo, NY?

The most popular types of Utilization Management jobs in Buffalo, NY are:

Infographic showing various Utilization Management Associate job openings in Buffalo, 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 82% Physical, 3% Hybrid, and 15% Remote job distribution.

Registered Nurse Utilization Review SCH

Buffalo, NY • On-site

Catholic Health System
Health Care and Social Assistance • 10K+ employees
Learn more about Catholic Health Systemexternal

Other

Posted 8 days ago

Catholic Health rating

7.9

Company rating: 7.9 out of 10

Based on 181 frontline employees who took The Breakroom Quiz

Job description

Facility: Sisters of Charity Hospital
Shift: Shift 1
Status: Full Time FTE: 1.000000
Bargaining Unit: ACE Associates
Exempt from Overtime: Exempt: Yes
Work Schedule: Days with Weekend and Holiday Rotation
Hours:
8am -4 pm
Summary:
The Registered Nurse (RN), Utilization Review, as an active member of the Middle Revenue Cycle and interdisciplinary care team, provides comprehensive Utilization Review to patients and families in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with the interdisciplinary team to maintain appropriate levels of care and to facilitate movement of the patient through the continuum. The Utilization Review RN identifies and removes barriers for delays of treatment. This individual also works to maintain third-party payer relationships related to Utilization Review Activities. This includes, but is not limited to, concurrent review, responding to inquiries, complaints, and other correspondence, and may include setting up discussions between parties. Knowledge of state and federal laws relating to contracts and utilization review process processes is vital.
Responsibilities:
EDUCATION
  • BSN degree or RN with a BS in health-related field and working knowledge/experience in documentation utilization review in an acute care/inpatient setting
  • Unrestricted NYS RN license
  • Holds, or will obtain within one year of hire, Certified Case Manager (CCM)
  • Certification in a Nationally Recognized Utilization Review Criteria set is preferred
  • At least one (1) year of experience in working with third party payers strongly preferred
EXPERIENCE
  • Minimum of three (3) years of experience working in an Acute Care Hospital Setting
  • Proficiency in utilization management and regulatory requirements preferred
  • Experience in working with people who are geographically dispersed preferred
  • Experience in working with third party payers strongly preferred
KNOWLEDGE, SKILL AND ABILITY
  • Strong clinical assessment skills and ability to articulate findings in a fast-paced environment. Possess the ability to make independent decisions within the professional scope of practice
  • Possess ability to educate, inform, advocate, promote and facilitate health care options, and demonstrate the willingness to work harmoniously with a team approach
  • Possesses ability to effectively and efficiently utilize technology within daily work with the care team and ability to quickly learn and adapt to new technology tools and software
  • Extensive knowledge of third-party payer guidelines, accreditation and regulatory requirements preferred
  • Knowledge of Managed Care Organization contracts/agreements preferred
WORKING CONDITIONS
  • Willingness to work beyond normal working hours, and in other positions temporarily, and/or at other locations when necessary
  • Variable schedule which may include weekends and holidays. May be requested to travel to multiple hospital and community sites
ENVIRONMENT
  • Normal heat, light space, and safe working environment; typical of most office jobs
  • Occasional exposure to one or more mildly unpleasant physical conditions
  • Minimum physical effort required, typical of most office work
  • Significant amount of walking within the acute care facility

What Catholic Health employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Catholic Health

Sourced by ZipRecruiter

Formed in 1998 under four religious sponsors, Catholic Health in Buffalo, NY is a non-profit healthcare system that provides care to Western New Yorkers across a network of hospitals, nursing homes, home care agencies, physician practices, and other community based ministries. Today, the system has two religious sponsors, the Diocese of Buffalo and the Franciscan Sisters of St. Joseph, who carried on its Mission across the Buffalo-Niagara region. Our mission sets us apart. It's the human side of healthcare – the touch, smile or comforting word that can help make your healthcare experience better. It's treating all people with respect and dignity, and providing comfort in times of greatest need. Catholic Health is making the largest investment in its history, dedicating more than $100 million in state-of-the- art technology that will connect our hospitals, home care, long-term care, clinician offices, health centers and ancillary services with patients throughout the area. This transformational investment marks a major milestone for our healing ministry, which dates back more than 165 years.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Buffalo, NY, US

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