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Utilization Management Jobs in Rochester, NY (NOW HIRING)

Lthc

Utilization Management Services Rep I

Rochester, NY

$15.75 - $21.50/hr

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers ...

Lthc

Utilization Management Services Rep I

Rochester, NY

$15.75 - $21.50/hr

This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. This position acts as a resource for both internal and external customers ...

Highland Hospital

RN Case Manager PC/FM

Rochester, NY · On-site

$37 - $45/hr

... utilization management, proactive patient management, care facilitation and treatment planning functions. The RN Care Manager manages clinical aspects of patient centered medical home, working with ...

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 ...

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All JobsUtilization Management JobsUtilization Management Jobs in Rochester, NY

Utilization Management information

See Rochester, NY salary details

$38.4K

$88.2K

$160.7K

How much do utilization management jobs pay per year?

As of Jun 12, 2026, the average yearly pay for utilization management in Rochester, NY is $88,218.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,600.00 and $103,000.00 per year, depending on experience, location, and employer.

What jobs pay 4000 a week without a degree?

Utilization Management roles typically require healthcare or insurance industry knowledge and often a relevant certification rather than a degree. High-paying jobs that can reach $4,000 a week without a degree include sales positions, real estate brokers, commercial pilots, or skilled trades like electricians and plumbers, especially with experience and certifications. These roles often involve commission, bonuses, or overtime to achieve such earnings.

What jobs pay $2000 a day?

Jobs that can pay $2000 a day typically include specialized roles such as senior management, high-level consultants, certain medical specialists, and experienced legal professionals. These positions often require advanced skills, extensive experience, and sometimes certifications, and they may involve freelance or contract work with high hourly or project-based rates.

What are the key skills and qualifications needed to thrive in the Utilization Management position, 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 is a Utilization Management job?

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 is the least stressful healthcare job?

Utilization management roles are often considered less stressful compared to direct patient care jobs because they involve reviewing medical necessity and insurance claims rather than providing hands-on treatment. These positions typically have regular hours, less physical demand, and focus on administrative tasks, making them a lower-stress option within healthcare. However, stress levels can vary based on workplace environment and individual preferences.

What does utilization management do?

Utilization management is a healthcare job that involves reviewing and approving or denying medical services to ensure they are necessary and appropriate. It helps control healthcare costs and maintains quality by evaluating treatment plans, often using guidelines and data analysis. Professionals in this role typically work with insurance companies, healthcare providers, and use tools like medical records and clinical criteria.

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 most commonly searched types of Utilization Management jobs in Rochester, NY? The most popular types of Utilization Management jobs in Rochester, NY are:
What are popular job titles related to Utilization Management jobs in Rochester, NY? For Utilization Management jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Rochester, NY look for? The top searched job categories for Utilization Management jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Utilization Management jobs? Cities near Rochester, NY with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Rochester, NY as of June 2026, with employment types broken down into 88% Full Time, 8% Part Time, and 4% Contract. Highlights an 100% In-person job distribution, with an average salary of $88,218 per year, or $42.4 per hour.

Utilization Management RN

UR Thompson Health

Canandaigua, NY • On-site

$35 - $47/hr

Full-time

Posted 9 days ago

Job description

Schedule: Full-time days- Monday through Friday with shared rotating weekends.
Fully in person position
Do you want to work in a culture where interdisciplinary teams come together to improve care, where your suggestions are welcomed and your ideas are part of the solution? Explore the Thompson difference and apply today!
UR Medicine's Thompson Health is the premier healthcare provider in the Finger Lakes region. You will enjoy a competitive salary and generous benefits, free onsite parking, an excellent staffing model and a modern, caring, high-tech environment.
Internal Title: Utilization Management / CDS Nurse ( RN )
UM/CDS Nurse Responsibilities:
  • Perform extensive record review in accordance with state regulations, ensuring compliance with changes affecting Utilization Management and Clinical Documentation Improvement.
  • Assess the appropriateness and medical necessity of treatment requests on a prospective, concurrent, and retrospective basis.
  • Collaborate with providers to determine appropriate admission status and potential changes using critical thinking skills and recognized criteria.
  • Interact frequently with providers, HIM professionals, Social Workers, nursing staff, patients/patients' caregivers, and insurance companies.
  • Review medical records to improve clinical documentation, representing the severity of illness, risk of mortality, and patient complexity.

Description:
  • Perform utilization review in accordance with state regulations, ensuring compliance with changes affecting Utilization Management
  • Collaborate with providers to determine appropriate admission status and potential changes.
  • Assess the appropriateness and medical necessity of treatment requests for utilization review on a prospective, concurrent, and retrospective basis.
  • Review patient records and evaluate progress, obtaining necessary medical reports and treatment plan requests.
  • Review medical records to improve the quality of clinical documentation, representing the severity of illness, risk of mortality, and patient complexity.
  • Provide review information to payers as requested.
  • Perform retroactive reviews for assigned denials and monitor steps throughout the denial process.
  • Write effective appeal letters and inform appropriate departments of outcomes.
  • Work with Medical Staff, Case Management/Social Work, Clinical Quality, and interdisciplinary care team to ensure quality patient outcomes through appropriate utilization of hospital resources.
  • Collect, analyze, and maintain data on the utilization of medical services and resources to identify trends and opportunities for improvement.
  • Serve as primary contact for Utilization Management related issues, both internally and externally.
  • Assess quality and clinical risk issues on a concurrent basis, reporting quality of care issues as identified.
  • Provide education to medical staff, department leaders, medical offices, and associates on Utilization Management principles, including the use of InterQual & Milliman criteria and CMS regulations.
  • Actively participate in committees and workgroups related to Utilization Management, Length of Stay Management, Readmissions and Observation services.
  • Collaborate and assist the manager in executing a Quality and Safety model, integrating regulatory mandates, and providing training for JC readiness.
  • Participate in team meetings and staff education in the Utilization Management process and Clinical Documentation Improvement Program.

Required Competencies:
  • Demonstrated Knowledge or willingness to learn: Utilization Management principles including knowledge of various regulatory and payer specific requirements.
  • Clinical Knowledge: Proficiency in clinical criteria and understanding of medical treatments and interventions.
  • Critical Thinking: Ability to assess the appropriateness and medical necessity of treatment requests.
  • Regulatory Awareness: Knowledge of state and federal regulations guiding the authorization, denial, and appeal processes.
  • Communication Skills: Effective interaction with providers, HIM professionals, Social Workers, nursing staff, patients, caregivers, and insurance companies.
  • Documentation Skills: Accurate and thorough documentation to support clinical decisions and ensure compliance.
  • Analytical Skills: Ability to collect, analyze, and maintain data on the utilization of medical services and resources.
  • Demonstrate attention to detail in all aspects of documentation and review processes.
  • Prioritize tasks effectively to manage multiple responsibilities and deadlines.
  • Adapt to changing situations and regulatory requirements in the healthcare environment.
  • Patient Advocacy: Ensuring patients receive appropriate and cost-effective healthcare services.
  • Collaboration: Working effectively with interdisciplinary teams to ensure quality patient outcomes.
  • Adaptability: Staying up to date with changes in healthcare regulations and best practices.
  • Lives the CARES values at all times.

Requirements:
Registered Nurse in NYS
Education:
  • A.A.S. in Nursing
  • B.S. in Nursing or other Health related field or willingness to get one within 5 years of employment.

Experience:
  • Minimum 5 years of acute nursing experience.
  • Prefer Utilization Review or Clinical Documentation Specialist experience.
  • Experience working with physicians in a collaborative supportive manner.
  • Knowledgeable in the use of nationally recognized criteria or willingness to learn.
  • Knowledgeable in reimbursement methodologies & interpretation of payer contracts or willingness to learn.
  • Experience with computer applications including Microsoft Office.
  • Preferred experience with Epic.
  • Preferred experience in writing effective appeal letters.

Complexity of Duties:
  • Performs a variety of duties requiring independent judgment and decision-making and adjusting priorities as needed.
  • Keeps abreast of complex and changing regulatory environment.
  • Handle difficult situations with providers, patients and caregivers, using strong communication skills to diffuse situations and reach resolution.
  • Effectively manage denials / appeals with attention to detail and follow-up.
  • Competently issues Notices of Status Change, MOONs and HINNs/ABNs when appropriate.

*** Shared weekends
Position Pay Range: $35.00-47.00/hour
Starting Pay: Based on experience
Thompson Health is an EOE encouraging individuals with disabilities and veterans to apply
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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