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Utilization Review Assistant Jobs in Rochester, NY

DePaul

Residential Assistant

Henrietta, NY · On-site

$21 - $21.30/hr

... Assistant to join our team! Under the direction of the Residence Manager, assists with the case ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

... Assistant to join our team! Under the direction of the Residence Manager, this role assists with ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

... Residential Assistant! Under the direction of the Residence Manager, assists with the case ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Henrietta, NY

$21 - $21.30/hr

... Assistant to join our team! Under the direction of the Residence Manager, assists with the case ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY

$21 - $21.30/hr

... Residential Assistant! Under the direction of the Residence Manager, assists with the case ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

... Assistant to join our team! Under the direction of the Residence Manager, this role assists with ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY

$21 - $21.30/hr

... Residential Assistant! Under the direction of the Residence Manager, assists with the case ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Henrietta, NY

$21 - $21.30/hr

... Assistant to join our team! Under the direction of the Residence Manager, assists with the case ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY

$21 - $21.30/hr

... Assistant to join our team! Under the direction of the Residence Manager, this role assists with ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

... Assistant! This role is every other weekend on the overnight shift. Under the direction of the ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY

$21 - $21.30/hr

... Assistant! This role is every other weekend on the overnight shift. Under the direction of the ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

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All JobsUtilization Review Assistant JobsUtilization Review Assistant Jobs in Rochester, NY

Utilization Review Assistant information

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How much do utilization review assistant jobs pay per hour?

As of Jun 21, 2026, the average hourly pay for utilization review assistant in Rochester, NY is $28.92, according to ZipRecruiter salary data. Most workers in this role earn between $16.40 and $35.50 per hour, depending on experience, location, and employer.

What is a Utilization Review Assistant job?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What are the key skills and qualifications needed to thrive in the Utilization Review Assistant position, and why are they important?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

What does a typical day look like for a Utilization Review Assistant and who do they work with?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What are the most commonly searched types of Utilization Review jobs in Rochester, NY? The most popular types of Utilization Review jobs in Rochester, NY are:
What are popular job titles related to Utilization Review Assistant jobs in Rochester, NY? For Utilization Review Assistant jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Utilization Review Assistant jobs in Rochester, NY look for? The top searched job categories for Utilization Review Assistant jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Utilization Review Assistant jobs? Cities near Rochester, NY with the most Utilization Review Assistant job openings:
Utilization Review Assistant jobs near you

Utilization Management RN

UR Medicine Thompson Health

Canandaigua, NY • On-site

$35 - $47/hr

Full-time

Posted 17 days ago

Job description

Schedule: Full-time days- Monday through Friday with shared rotating weekends.
Fully in person position
Do you want to work in a culture where interdisciplinary teams come together to improve care, where your suggestions are welcomed and your ideas are part of the solution? Explore the Thompson difference and apply today!
UR Medicine's Thompson Health is the premier healthcare provider in the Finger Lakes region. You will enjoy a competitive salary and generous benefits, free onsite parking, an excellent staffing model and a modern, caring, high-tech environment.
Internal Title: Utilization Management / CDS Nurse ( RN )
UM/CDS Nurse Responsibilities:
  • Perform extensive record review in accordance with state regulations, ensuring compliance with changes affecting Utilization Management and Clinical Documentation Improvement.
  • Assess the appropriateness and medical necessity of treatment requests on a prospective, concurrent, and retrospective basis.
  • Collaborate with providers to determine appropriate admission status and potential changes using critical thinking skills and recognized criteria.
  • Interact frequently with providers, HIM professionals, Social Workers, nursing staff, patients/patients' caregivers, and insurance companies.
  • Review medical records to improve clinical documentation, representing the severity of illness, risk of mortality, and patient complexity.

Description:
  • Perform utilization review in accordance with state regulations, ensuring compliance with changes affecting Utilization Management
  • Collaborate with providers to determine appropriate admission status and potential changes.
  • Assess the appropriateness and medical necessity of treatment requests for utilization review on a prospective, concurrent, and retrospective basis.
  • Review patient records and evaluate progress, obtaining necessary medical reports and treatment plan requests.
  • Review medical records to improve the quality of clinical documentation, representing the severity of illness, risk of mortality, and patient complexity.
  • Provide review information to payers as requested.
  • Perform retroactive reviews for assigned denials and monitor steps throughout the denial process.
  • Write effective appeal letters and inform appropriate departments of outcomes.
  • Work with Medical Staff, Case Management/Social Work, Clinical Quality, and interdisciplinary care team to ensure quality patient outcomes through appropriate utilization of hospital resources.
  • Collect, analyze, and maintain data on the utilization of medical services and resources to identify trends and opportunities for improvement.
  • Serve as primary contact for Utilization Management related issues, both internally and externally.
  • Assess quality and clinical risk issues on a concurrent basis, reporting quality of care issues as identified.
  • Provide education to medical staff, department leaders, medical offices, and associates on Utilization Management principles, including the use of InterQual & Milliman criteria and CMS regulations.
  • Actively participate in committees and workgroups related to Utilization Management, Length of Stay Management, Readmissions and Observation services.
  • Collaborate and assist the manager in executing a Quality and Safety model, integrating regulatory mandates, and providing training for JC readiness.
  • Participate in team meetings and staff education in the Utilization Management process and Clinical Documentation Improvement Program.

Required Competencies:
  • Demonstrated Knowledge or willingness to learn: Utilization Management principles including knowledge of various regulatory and payer specific requirements.
  • Clinical Knowledge: Proficiency in clinical criteria and understanding of medical treatments and interventions.
  • Critical Thinking: Ability to assess the appropriateness and medical necessity of treatment requests.
  • Regulatory Awareness: Knowledge of state and federal regulations guiding the authorization, denial, and appeal processes.
  • Communication Skills: Effective interaction with providers, HIM professionals, Social Workers, nursing staff, patients, caregivers, and insurance companies.
  • Documentation Skills: Accurate and thorough documentation to support clinical decisions and ensure compliance.
  • Analytical Skills: Ability to collect, analyze, and maintain data on the utilization of medical services and resources.
  • Demonstrate attention to detail in all aspects of documentation and review processes.
  • Prioritize tasks effectively to manage multiple responsibilities and deadlines.
  • Adapt to changing situations and regulatory requirements in the healthcare environment.
  • Patient Advocacy: Ensuring patients receive appropriate and cost-effective healthcare services.
  • Collaboration: Working effectively with interdisciplinary teams to ensure quality patient outcomes.
  • Adaptability: Staying up to date with changes in healthcare regulations and best practices.
  • Lives the CARES values at all times.

Requirements:
Registered Nurse in NYS
Education:
  • A.A.S. in Nursing
  • B.S. in Nursing or other Health related field or willingness to get one within 5 years of employment.

Experience:
  • Minimum 5 years of acute nursing experience.
  • Prefer Utilization Review or Clinical Documentation Specialist experience.
  • Experience working with physicians in a collaborative supportive manner.
  • Knowledgeable in the use of nationally recognized criteria or willingness to learn.
  • Knowledgeable in reimbursement methodologies & interpretation of payer contracts or willingness to learn.
  • Experience with computer applications including Microsoft Office.
  • Preferred experience with Epic.
  • Preferred experience in writing effective appeal letters.

Complexity of Duties:
  • Performs a variety of duties requiring independent judgment and decision-making and adjusting priorities as needed.
  • Keeps abreast of complex and changing regulatory environment.
  • Handle difficult situations with providers, patients and caregivers, using strong communication skills to diffuse situations and reach resolution.
  • Effectively manage denials / appeals with attention to detail and follow-up.
  • Competently issues Notices of Status Change, MOONs and HINNs/ABNs when appropriate.

*** Shared weekends
Position Pay Range: $35.00-47.00/hour
Starting Pay: Based on experience
Thompson Health is an EOE encouraging individuals with disabilities and veterans to apply
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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