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Utilization Management Jobs in Rochester, NY (NOW HIRING)

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Utilization Management information

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$38.5K

$88.3K

$160.9K

How much do utilization management jobs pay per year?

As of Sep 7, 2026, the average yearly pay for utilization management in Rochester, NY is $88,330.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,700.00 and $103,200.00 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 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 August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $88,330 per year, or $42.5 per hour.

Nurse Navigator - Family Planning Clinic

Rochester Regional Health

Rochester, NY • On-site

Full-time

Posted 5 days ago

Rochester Regional Health rating

7.3

Company rating: 7.3 out of 10

Based on 221 frontline employees who took The Breakroom Quiz

305th of 898 rated healthcare providers

Job description

Job Title: Nurse Navigator - Family Planning Clinic
Location: St. Mary's OBGYN - 65 Genesee St Ste 3, Rochester, NY 14611
Hours Per Week: 40
Schedule: Monday-Friday 8am-4pm
SUMMARY
Provides proactive case coordination/patient navigation for patients, including triage management, algorithm management, utilization management and resource management. Organizes services across the continuum from pre-registration through discharge from the Center to affect optimal patient outcomes, achieve continuity and quality of care, reduces cost and provide customer satisfaction. Provides assistance to patients and families through evaluation of social, emotional and financial needs and coordinates and facilitates appropriate resources. Communicates with third party payors, follows Health System policies and procedures, and assist with continually improving the quality and effectiveness of case management/patient navigation.
RESPONSIBILITIES
  • Reviews the medical record with referring provider as soon as possible after admission-within the first 12 to 24 hours. Applies utilization review criteria to assess and document appropriateness of admission, continued stay and level of care.
  • Interviews patients and/or family members to obtain information about social, emotional, and financial factors which impact health status. Assesses needs for progress along department algorithm of care and continuing care or resource support following discharge.
  • Responds to referrals from patients, families, physicians, hospital staff, and community agencies. Collaborates with patient/family and members of health care team to develop appropriate post-hospital plans for continuing care or resource support following discharge. Utilize all appropriate medical, social, and financial resources available to support the patient/family and to ensure smooth transition to appropriate levels of care.
  • Responds to referrals from patients, families, physicians, hospital staff, and community agencies. Collaborates with patient/family and members of health care team to develop appropriate post-hospital plans for continuing care, to initiate referrals.
  • Proactively identifies problems with utilization of resources and assures specific tests, consults etc. are done in a timely manner. Feedback is obtained and documented in the patient chart. Forward patient chart to physician for review when problems are identified. Intercedes with appropriate department or attending physician to identify cause. Communicates as needed with Physician Advisor, assures patient is placed on clinical pathway and monitors variances from pathway as appropriate.
  • Maintains current information on community resources, third party payors, and managed care environment. Knowledgeable of changing rules/regulations, and policies/procedures. Maintains established departmental policies and procedures, objectives, quality management plan, environmental and infection control standards.
  • Maintains appropriate and timely documentation through medical record entries, daily logs, computer entries, and monthly statistics. Prepares and maintains required documentation on each patient.
  • Completes worksheets, communicates in a timely manner with physicians and coders, provides necessary statistics for data collection, and identifies case mix issues.
  • May provide consultation and education to medical and hospital staff of inpatient and outpatient programs regarding role of case management. This may include appropriate management of resources, discharge planning and complex medical/legal issues.
  • Assists in development of new services or policies appropriate to patient needs and consistent with strategic plan
  • Makes referrals to administrative director, medical director, quality management, risk management, infection control, and hospital departments when potential quality problems are identified. Refers to and consults with clinical social worker on patients with complex psychosocial/financial needs. Develops and maintains professional working relationship with medical staff, hospital staff, and coworkers.
  • Maintains strict confidentiality at all times.
  • Ensures that quality of patient care is maintained by collecting quality indicators and clinical path variance data, as well as identifying data that indicates potential areas for improvement. Participates actively on clinical pathway, CQL, and clinical process improvement teams. May act as team member, team leader, facilitator, or recorder.
  • Provides services, supports or other assistance in a culturally sensitive manner responsive to the patient/families beliefs, attitudes, language and behaviors.
  • Provides care appropriate to each patient.
  • Develop and maintain strong working relationships with all key internal stakeholders including physicians and center leadership.
  • Ensure strict adherence to all established Unity processes, procedures and standards.

REQUIRED QUALIFICATIONS
  • Graduate of an approved school of nursing, BSN preferred.
  • Minimum of five years of experience in a health care setting, of which a minimum of two years has been spent in acute care setting.
  • Current licensure as an RN in the state of New York.

PREFERRED QUALIFICATIONS
  • Prior experience in women's health strongly preferred.

EDUCATION:
AS: Nursing (Required)
LICENSES / CERTIFICATIONS:
BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - NYS Office of Professions
PHYSICAL REQUIREMENTS:
Light - Clinical - Light clinical roles involve frequent standing and walking, with occasional lifting of light objects (≤20 lbs.) and routine reaching, grasping, and fine manipulation for tasks such as patient care, laboratory work, or specimen processing. Staff rely on strong visual and auditory acuity to accurately observe specimens, read instrumentation, monitor patients, respond to alarms, and communicate effectively with care teams. Cognitive demands include multitasking, prioritizing clinical and laboratory workflows, and coordinating with interdisciplinary teams. Emotional resilience is necessary due to frequent interruptions, shifting priorities, and the need for precise and compassionate interaction with patients and colleagues. Environmental exposures may include infectious materials, biological specimens, cleaning agents, sharps, chemical reagents, and wet surfaces. PPE use, TB testing, and schedule flexibility are commonly required.
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:
$80,753.00 - $110,292.00
CITY:
Rochester
POSTAL CODE:
14611
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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