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Utilization Manager Jobs in Troy, NY (NOW HIRING)

Albanymed

Utilization Review Nurse

Albany, NY

$77K - $119K/yr

Care Management/Social Work Work Shift: Day (United States of America) Salary Range: $77,075.00 - $119,466.00 Responsible for Utilization Management, Quality Screening and Delay Management for ...

Albany Med

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

Care Management/Social Work Work Shift: Day (United States of America) Salary Range: $77,075.00 - $119,466.00 Responsible for Utilization Management, Quality Screening and Delay Management for ...

Albany Medical Center

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

Care Management/Social Work Work Shift: Day (United States of America) Salary Range: $77,075.00 - $119,466.00 Responsible for Utilization Management, Quality Screening and Delay Management for ...

Albany Med

Nurse Case Manager

Albany, NY · On-site

$77K - $119K/yr

The Case Manager works proactively with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to achieve ...

Albanymed

Nurse Case Manager

Albany, NY · On-site

$77K - $119K/yr

The Case Manager works proactively with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to achieve ...

Albany Medical Center

Nurse Case Manager

Albany, NY · On-site

$77K - $119K/yr

The Case Manager works proactively with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to achieve ...

Accenture

Clinical Management Manager

Albany, NY · On-site

$94K - $293K/yr

Design and implement care delivery models, workflows, and utilization management solutions * Drive measurable improvements in patient flow, capacity, LOS, and avoidable utilization * Partner with ...

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Troy, NY

Utilization Manager information

See Troy, NY salary details

$38.4K

$89.5K

$164.7K

How much do utilization manager jobs pay per year?

As of Aug 26, 2026, the average yearly pay for utilization manager in Troy, NY is $89,501.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,500.00 and $107,700.00 per year, depending on experience, location, and employer.

What is a utilization manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

What are the key skills and qualifications needed to thrive as a utilization manager?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by utilization managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

More about Utilization Manager jobs

What are popular job titles related to Utilization Manager jobs in Troy, NY?

For Utilization Manager jobs in Troy, NY, the most frequently searched job titles are:

What job categories do people searching Utilization Manager jobs in Troy, NY look for?

The top searched job categories for Utilization Manager jobs in Troy, NY are:

What cities near Troy, NY are hiring for Utilization Manager jobs?

Cities near Troy, NY with the most Utilization Manager job openings:

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Troy, NY as of August 2026, with employment types broken down into 84% Full Time, 15% Part Time, and 1% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $89,501 per year, or $43 per hour.

Utilization Review Nurse

Albanymed

Albany, NY

$77K - $119K/yr

Full-time

Posted 12 days ago

Job description

Department/Unit:

Care Management/Social Work

Work Shift:

Day (United States of America)

Salary Range:

$77,075.00 - $119,466.00Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients.

Completes Utilization Management and Quality Screening for assigned patients.
Applies MCG criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Departmental standards.
While performing utilization review identifies areas for clinical documentation improvement and contacts appropriate department.
Identifies at-risk populations using approved screening tool and follows established reporting procedures.
Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures and follows up as indicated.
Communicates covered day reimbursement certification for assigned patients.
Discusses payor criteria and issues and a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
Uses quality screens to identify potential issues and forwards information to the Quality Department.
Demonstrates proper use of MCG and documentation requirements through case review and inter-rater reliability studies.
Facilitates removal of delays and documents delays when they exist. Reports internal and external delays to the Triad Team.
Collaborates with the health care team and appropriate department in the management of care across the continuum of care by assuring communication with Triad Team and health care team.

Minimum Qualifications:
Registered nurse with a New York State current license.
Associate's degree required. Bachelor's degree preferred.
Minimum of three years clinical experience in an assigned service.
Recent experience in case management, utilization management and/or discharge planning/home care in a high volume, acute care hospital preferred. PRI and
Case Management certification preferred.
Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management.
Self-directed with the ability to adapt in a changing environment.
Basic knowledge of computer systems with skills applicable to utilization review process.
Excellent written and verbal communication skills.
Working knowledge of MCG criteria and ability to implement and utilize.
Understanding of Inpatient versus Outpatient surgery and ICD10-Coding (preferred) and Observation status qualifications.
Ability to work independently and demonstrate organizational and time management skills.
Strong analytic, data management and PC skills.
Working knowledge of Medicare regulatory requirements, Managed Care Plans

Thank you for your interest in Albany Med Health System!

Albany Med Health System is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Med Health System, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a "need to know" and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Health System policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

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