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Utilization Review 1099 Jobs in Rochester, NY (NOW HIRING)

Highland Hospital

RN Case Manager (Hospital)

Rochester, NY · On-site

$77K - $93K/yr

... utilization management, proactive patient management, care facilitation and treatment planning ... Complete the Patient Review Instrument * Other duties as assigned Salary Range: $77,220.15- $93,600 ...

Highland Hospital

RN Case Manager (Hospital)

Rochester, NY · On-site

$77K - $93K/yr

... utilization management, proactive patient management, care facilitation and treatment planning ... Complete the Patient Review Instrument * Other duties as assigned Salary Range: $77,220.15- $93,600 ...

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Utilization Review 1099 information

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How much do utilization review 1099 jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for utilization review 1099 in Rochester, NY is $41.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

What is a utilization review 1099?

A Utilization Review 1099 position refers to a healthcare professional, often a nurse or therapist, who works as an independent contractor (not a direct employee) to review medical cases for necessity and efficiency. The '1099' designation means they receive a Form 1099 for tax purposes and are responsible for their own taxes. Utilization Review specialists evaluate patient records to ensure treatments are appropriate and meet insurance or regulatory guidelines. These roles are often remote and offer flexible hours, but do not provide traditional employee benefits.

What are the key skills and qualifications needed to thrive as a utilization review 1099?

To thrive as a Utilization Review 1099 professional, you need a strong clinical background (often as a registered nurse or similar), experience with medical necessity criteria, and familiarity with insurance guidelines. Proficiency with utilization management software, electronic health records (EHRs), and knowledge of regulatory requirements are typically required, along with URAC or CCM certification being advantageous. Excellent analytical thinking, attention to detail, and effective communication skills are essential for collaborating with healthcare providers and payers. These skills ensure accurate, efficient review of patient care for coverage decisions, compliance, and cost-effective healthcare delivery.

What are some typical challenges faced by utilization review 1099 contractors, and how can they be managed?

Utilization Review professionals working as 1099 contractors often face challenges such as fluctuating caseloads, varying client requirements, and the need to stay current with changing regulations independently. Unlike full-time employees, contractors must also manage their own schedules, billing, and sometimes provide their own resources and training. To succeed, it's important to establish clear communication with clients, maintain up-to-date credentials, and leverage professional networks or continuing education resources to stay informed about industry changes.

What is the difference between Utilization Review 1099 vs Utilization Review Nurse?

AspectUtilization Review 1099Utilization Review Nurse
CredentialsVaries; often self-employed or independent contractorsRegistered Nurse (RN) license required
Work EnvironmentRemote or freelance; contract basisHealthcare facilities, insurance companies, or clinics
Employer/Industry UsageFreelance or independent consulting in healthcareHospitals, insurance providers, healthcare organizations
Work FocusReviewing medical necessity for insurance claimsAssessing patient records, making clinical decisions

Utilization Review 1099 typically refers to independent contractors reviewing insurance claims, often working remotely. Utilization Review Nurse is a licensed RN performing clinical assessments within healthcare settings. While both roles involve utilization review, the 1099 role emphasizes independent contracting, whereas the nurse role requires clinical credentials and direct patient or clinical record involvement.

What are popular job titles related to Utilization Review 1099 jobs in Rochester, NY?

For Utilization Review 1099 jobs in Rochester, NY, the most frequently searched job titles are:

What job categories do people searching Utilization Review 1099 jobs in Rochester, NY look for?

The top searched job categories for Utilization Review 1099 jobs in Rochester, NY are:

What cities near Rochester, NY are hiring for Utilization Review 1099 jobs?

Cities near Rochester, NY with the most Utilization Review 1099 job openings:

Utilization Review 1099 jobs near you
Infographic showing various Utilization Review 1099 job openings in Rochester, NY as of June 2026, with employment types broken down into 3% As Needed, 81% Full Time, 8% Part Time, and 8% Contract. Highlights an 84% In-person, and 16% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.

Registered Nurse (RN) Case Manager, Palliative Home Care (Full-Time, Days)

Rochester Regional Health

Rochester, NY • On-site

$77K - $103K/yr

Full-time

Re-posted 25 days ago

Rochester Regional Health rating

7.3

Company rating: 7.3 out of 10

Based on 218 frontline employees who took The Breakroom Quiz

307th of 888 rated healthcare providers

Job description

Job Title: Registered Nurse Case Manager
Department:PALLIATIVE CARE NURSING - Monroe County
Location: Rochester Regional Health Home Care - Monroe Ave
Hours Per Week: 40
Schedule: Monday - Friday, 8:30am-5:00pm
Rochester Regional Health Home Care is the only home care provider in the region to earn a CMS 5-Star Quality of Patient Care rating, placing its CHHA among the top 3.5% of agencies nationwide.
In addition, CHHA was recognized by U.S. News & World Report as a "High Performing Home Care Agency," further highlighting its commitment to exceptional patient care and clinical excellence.
Why Join Our Team?
  • Set your own work schedule to fit your lifestyle and work-life balance
  • Mileage reimbursement + paid drive time between patient visits
  • Shift differentials to reward your flexibility
  • Overtime opportunities for additional earning potential
  • Up to $10,000 in tuition assistance for BSN to MSN advancement
  • Tuition and student loan assistance programs to support your financial goals
  • Comprehensive full benefits package

SUMMARY
The RN Case Manager is responsible for the delivery of comprehensive nursing care to a set of assigned patients at a specific point in time. This involves the assessment of patient and family needs and the development, implementation and evaluation of an appropriate Plan of Care, making changes in response to changing patient needs. The RN Case Manager identifies appropriate interdisciplinary services needed, coordinates those services and supervises Private Duty Nurses (PDN) as applicable.
RESPONSIBILITIES
  • Identifies and prioritizes health problems based on assessment
  • Develops or implements an interdisciplinary Plan of Care based on the needs identified during the assessment, with input from the patient (and their caregivers as applicable), in collaboration with the attending physician and other care team members
  • Manages and coordinates patient care, including clinically complex cases, in a manner which ensures the efficient and effective delivery of appropriate services and community supports
  • Exhibits proficiency and accuracy in the completion of comprehensive assessment/documentation, which may include assessments required by payer sources (e.g., Outcome and Assessment Information Set (OASIS), Hospice Item Set (HIS)).
  • Plans, organizes and prioritizes care needs for an assigned caseload of patients to ensure their care needs are met and services are delivered according to plan of care
  • Communicates all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner
  • Facilitates the development and implementation of patient discharge plans as indicated
  • Documents all patient care and coordinating activities per agency standards
  • Assesses the need for additional services (aide, therapies, social work or a community service) and obtains orders and arranges care as indicated
  • Supervises and evaluates care provided by Licensed Practical Nurses and/or home health aides in the performance of his/her patient care duties
  • Works collaboratively with other care team members by communicating all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner.
  • Correctly identifies patient/family risk factors and establishes goals and interventions to reduce/remove risk from the plan of care to enable patients to remain in the least restrictive care setting. Coordinate/participate in interdisciplinary team meetings/patient care conferences.
  • Patient needs are prioritized; visits outside primary team assignment or geographical area may be required in order to meet patient need.
  • Practices according to Agency and community standards
  • Participates in utilization review and/or continuous quality improvement activities as requested.
  • Attends required staff meetings, in-services and/or supervisory conferences.
  • Participates in on-call schedule and weekend/holiday schedule as assigned.

REQUIRED QUALIFICATIONS
  • Diploma or Associate's Degree in Nursing
  • Registered Nurse license in New York State

PREFERRED QUALIFICATIONS
  • 1 year of nursing experience
  • Prior home health, clinical and direct patient care experience

EDUCATION:
LICENSES / CERTIFICATIONS:
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:
$77,983.00 - $103,906.00
CITY:
Rochester
POSTAL CODE:
14607
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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