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Utilization Management Jobs in New Rochelle, NY (NOW HIRING)

CareConnect

Utilization Review RN

Greenvale, NY · On-site

Provides timely and thorough case screening to identify case management needs and make appropriate ... Responds to outstanding utilization management issues and inquiries made via overnight voicemail ...

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Utilization Management information

See New Rochelle, NY salary details

$40.1K

$92.1K

$167.7K

How much do utilization management jobs pay per year?

As of Aug 17, 2026, the average yearly pay for utilization management in New Rochelle, NY is $92,083.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,400.00 and $107,500.00 per year, depending on experience, location, and employer.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

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

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What are popular job titles related to Utilization Management jobs in New Rochelle, NY?

For Utilization Management jobs in New Rochelle, NY, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in New Rochelle, NY look for?

The top searched job categories for Utilization Management jobs in New Rochelle, NY are:

What cities near New Rochelle, NY are hiring for Utilization Management jobs?

Cities near New Rochelle, NY with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in New Rochelle, NY as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 12% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 4% Hybrid, and 5% Remote job distribution, with an average salary of $92,083 per year, or $44.3 per hour.

Nurse Case Manager, Utilization Management

1199SEIU Funds

Manhattan, NY

Full-time

Re-posted 6 days ago

Job description


Responsibilities
Use industry criteria, benefit plan design, clinical knowledge, and critical thinking to assess, plan and provide, ongoing coordination and management of service delivery through an integrated case management approach
Performs medical necessity review that includes concurrent, prospective, retrospective reviews and 1st level appeals, to ensure compliance with applicable criteria, medical policy, member eligibility, benefits and vendor contracts.
Apply Milliman Care Guidelines, internal Policies and Reference Guides to determine appropriateness of services/equipment that require Prior Authorization
Maintain accurate records of all patient/provider/vendor related interactions in designated medical management system
Apply clinical guidelines, provide recommendations and discuss cases with Medical Consultants
Meet timelines and quality standards related to Utilization Management
Maintain and submit reports and logs on reviewed activities as outlined by the UM program operational procedures,
Identify and participate in quality improvement activities as it relates to internal programs, processes studies and projects
Authorize vendor services using clinically proven criteria to make consistent care decisions
Maintain compliance with all state mandated regulations
Identify and problem solve issues with appropriate services to ensure positive member outcomes utilizing cost efficient covered services
Responsible for abiding by and supporting the care management programs in order to ensure quality and efficient clinical operations
Perform additional duties and projects as assigned by management


Qualifications
Bachelor's degree Valid New York State Registered Nurse (RN) required
Minimum three (3) years Medical/Surgical experience plus a minimum of two (2) years Utilization Management experience required
BSN and Certification in Case Management a plus
Proficient in application and use of industry standard Utilization Management criteria (Milliman Care Guidelines), Medicare and coverage guidelines, health claims processing, medical coding
Excellent verbal and written communication skills, problem-solving, clinical assessment, care planning skills, and independent decision-making capability
Computer and organizational skills required, ability to manage competing priorities, multi-task with results-oriented outcomes and work in a fast paced environment. Intermediate skills of Microsoft Office systems preferred.

Employment Type: Full time

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