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

Pride Health

Utilization Review Nurse

Manhattan, NY · On-site

$60 - $61/hr

Care Manager (RN) - Non-Patient-Facing - MLTC Location: New York, NY 10004 Schedule: Monday-Friday ... Perform utilization review and discharge planning. * Collaborate with providers and ...

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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 Sep 9, 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 degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

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, 77% Full Time, 20% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $92,083 per year, or $44.3 per hour.

Utilization Management (UM) Clinical Team Lead (RN, LPN or PT)

Manhattan, NY • On-site

MetroPlusHealth
Insurance Services • 1 - 5K employees
Learn more about MetroPlusHealthexternal

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Re-posted 3 days ago

MetroPlusHealth rating

6.7

Company rating: 6.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

277th of 315 rated insurance

Job description

Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health + Hospitals
MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.
Position Overview:
The Clinical Team Lead, under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatient and inpatient. The Clinical Team Lead will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members.
Work Shifts
9:00 AM - 5:00 PM
Duties & Responsibilities
  • Performs care management including hospital admission certification, continued stay review, discharge planning, outpatient, and ancillary services review, etc., following established MetroPlusHealth Utilization Management policies, procedures, and protocols.
  • Oversee the coordination and delivery of comprehensive, quality healthcare and services for all members requiring care management in a cost-effective manner.
  • Interacts and obtains relevant clinical information from members' PCP and other providers; approves care that meets established criteria; and refers all other cases to the MetroPlusHealth Physician Advisor/Medical Director.
  • Inform member and provider of Utilization Management determinations and treatment alternatives.
  • Identifies utilization trends and potential member needs by means of generating reports of encounter data, pharmacy data review, and new member health assessment forms.
  • Evaluate member needs for referred cases (from providers or member self-referred).
  • Assists all departments with the resolution of members' problems related to utilization management issues.
  • Performs all Utilization Management activities in compliance with all regulatory agency requirements.
  • Conducts medical record reviews as appropriate to case management functions.
  • Participate in Medical Management grand rounds with the Physician Advisor.
  • Performs all other duties as assigned
Minimum Qualifications
  • High School Diploma General Equivalency Diploma (GED) required; and
  • 2-5 years' clinical experience in an acute or applicable care setting.
  • UM/UR experience in managed care or hospital setting required
Licensure and/or Certification Required:
  • Valid New York State license and current registration to practice as a Registered Professional Nurse (RN), License Practical Nurse (LPN), or Physical Therapist (PT) issued by the New York State Education Department (NYSED).
Professional Competencies:
  • Integrity and Trust
  • Customer Focus
  • Excellent communication, written and analytical skills.
  • Knowledge of computer systems.

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