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Utilization Management Jobs in Rochester, NY (NOW HIRING)

Mvphealthcare

Clinical Appeals RN

Rochester, NY · Hybrid

You will collaborate closely with Medical Directors, Utilization Management, and Case Management teams to support informed decision-making and ensure alignment with organizational policies and ...

Highland Hospital

RN Care Coordinator

Rochester, NY · On-site

$77K - $93K/yr

... and utilization management, proactive patient management, care facilitation and treatment planning functions. The Clinical Care Coordinator/Care Manager may manage clinical aspects of patient ...

Highland Hospital

RN Care Manager

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 ...

Mvphealthcare

Concurrent Review - RN

Rochester, NY · Remote

$69K - $92K/yr

Ideal for experienced RNs looking to expand into utilization management, this position provides exposure to complex clinical decision-making, healthcare policy interpretation, and care coordination ...

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Utilization Management information

See Rochester, NY salary details

$37.5K

$86K

$156.7K

How much do utilization management jobs pay per year?

As of Jul 7, 2026, the average yearly pay for utilization management in Rochester, NY is $86,048.00, according to ZipRecruiter salary data. Most workers in this role earn between $62,000.00 and $100,500.00 per year, depending on experience, location, and employer.

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 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 July 2026, with employment types broken down into 94% Full Time, 3% Part Time, and 3% Contract. Highlights an 97% In-person, and 3% Remote job distribution, with an average salary of $86,048 per year, or $41.4 per hour.
Care Facilitator- St. Lawrence Region

Care Facilitator- St. Lawrence Region

Rochester Regional Health

Rochester, NY • On-site

$70K - $95K/yr

Full-time

Posted 21 days ago

Rochester Regional Health rating

7.4

Company rating: 7.4 out of 10

Based on 216 frontline employees who took The Breakroom Quiz

256th of 877 rated healthcare providers

Job description

Job Title: Care Facilitator
Department: Case Management
Location: Canton-Potsdam Hospital
Hours Per Week: 40 scheduled weekly hours
Schedule: 8-hour day shifts, 1 weekend every 4 weeks will be required
SUMMARY: Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize system variation and service delivery barriers that prevent achievement of optimal patient outcomes in the expected time frame and with most efficient utilization of resources. Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care. Performs as an integral part of the interdisciplinary team promoting interdisciplinary collaboration and champions service excellence. Facilitates assignment of level of care, considers payer requirements and responds accordingly to avoid adverse financial consequence to patient and hospital. Provide superior customer service by modeling the Brand Promise and Core Values.
RESPONSIBILITIES:
  • Conducts clinical reviews using Interqual criteria to determine appropriate patient level of care, document medical necessity, and support reimbursement.
  • Monitors resource utilization through continued stay reviews, manages length of stay, and coordinates with Physician Advisors for complex cases.
  • Serves as a liaison between hospital and payors, ensuring accurate communication of clinical information, supporting appeals, and optimizing benefit use.
  • Collaborates with care teams to resolve barriers to care, participates in daily huddles, and uses data to identify opportunities for process improvement.

REQUIRED QUALIFICATIONS:
  • Diploma from an accredited nursing school program or Associate's Degree
  • 3 years acute hospital care experience
  • Licensed in New York State as a Registered Nurse

PREFERRED QUALIFICATIONS:
  • Case Management or Utilization Management experience
  • Bachelor's Degree

EDUCATION:
LICENSES / CERTIFICATIONS:
BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), RN - Registered Nurse - New York State Education Department (NYSED)New York State Education Department (NYSED)New York State Education Department (NYSED)
PHYSICAL REQUIREMENTS:
M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$70,000.00 - $95,000.00
CITY:
Potsdam
POSTAL CODE:
13676
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

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