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Utilization Management Jobs in Rochester, NY (NOW HIRING)

w3r Consulting

Clinical Pharmacist

Rochester, NY · On-site

$55/hr

Utilization Management (UM) Focus: The clinical pharmacist position is responsible for and participates in a wide range of provider, patient, employer initiatives and programs. The pharmacist ...

Rochester Regional Health

Care Manager-RN

Irondequoit, NY · On-site

$82K - $113K/yr

Three (3) years of acute hospital care, case management or utilization management experience preferred * Excellent oral and written communication and interpersonal skills * Good understanding of ...

Rochester Regional Health

Care Manager-RN

Rochester, NY · On-site

$82K - $113K/yr

Three (3) years of acute hospital care, case management or utilization management experience preferred * Excellent oral and written communication and interpersonal skills * Good understanding of ...

Pwc

Oracle PMO - Manager

Rochester, NY

$99K - $232K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... utilization of business applications. As a Manager, you will enhance your leadership style by motivating, developing, and inspiring others to deliver quality. You are responsible for coaching ...

Health Plus Management

Physician Assistant

Bergen, NY · On-site

$70 - $85/hr

  • Medical

  • PTO

... management and Physical Medicine & Rehabilitation practice. Synergy Spinecare has two ... Computer Skills in utilization of EMR Schedule: Full and part time opportunities available Salary ...

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Showing results 41-60

All JobsUtilization Management JobsUtilization Management Jobs in Rochester, NY

Utilization Management information

See Rochester, NY salary details

$38.5K

$88.3K

$160.8K

How much do utilization management jobs pay per year?

As of Aug 17, 2026, the average yearly pay for utilization management in Rochester, NY is $88,283.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,600.00 and $103,100.00 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 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 94% Full Time, and 6% Contract. Highlights an 100% In-person job distribution, with an average salary of $88,283 per year, or $42.4 per hour.

Health Insurance & Authorization Specialist II

Highland Hospital of Rochester

Rochester, NY • On-site

$20.99 - $28.34/hr

Other

Re-posted 26 days ago

Job description


he Health Insurance and Authorization Specialist is responsible for verifying patient insurance eligibility and coverage and securing third-party payer authorization for our urgent/emergent inpatients, observation cases, maternity, and newborn admissions and notifies Utilization Management of clinical requests during the hospital stay. The Specialist also works closely with the uninsured/underinsured for appropriate referrals to our Financial Case Management team to assess patients for health insurance or financial assistance. They track our Medicare patients for benefit exhaustion to ensure compliance with Medicare Life Time Reserve (LTR) consent forms and consistently exercise judgment to resolve insurance barriers on the assigned admissions to avoid billing delays. This role involves a more significant amount of external coordination with outside agencies, including MVA/WC carriers, Motor Vehicle Accident Indemnification Corporation (MVAIC) agency, attorney offices, and works with parents to add their newborn through the NYS Marketplace or employer group.
Supervision: Responsible for monitoring own performance on assigned tasks. Self-directed and must make complex decisions independently. May train other support staff.
This role may have the option to work a hybrid-remote schedule and communicate daily through virtual meetings.
Salary Range:
$20.99- $28.34 an hour
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Job Requirements
  1. Education: High school Diploma or equivalent required. Associate degree preferred in related discipline (admitting/registration/patient billing/insurance); or equivalent experience
  2. Experience: Minimum of 3 years of related experience preferably in a hospital setting, medical office billing and or knowledge of third-party insurance regulations.
  3. Skills: Require high degree of professionalism and motivation with excellent communication and customer service skills, and medical terminology. Good interpersonal and telephone skills. Detail oriented. Computer, copier and FAX skills.

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