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Utilization Review Assistant Jobs in Rochester, NY

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · On-site

$60 - $65/hr

Engage in the Utilization Review process for assigned cases every month * Respond to clinical ... These tools assist our recruitment team but do not replace human judgment. Final hiring decisions ...

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · Remote

$60 - $65/hr

Engage in the Utilization Review process for assigned cases every month * Respond to clinical ... These tools assist our recruitment team but do not replace human judgment. Final hiring decisions ...

University of Rochester

Dental Assistant (s)

Rochester, NY · On-site

$20.30 - $27.41/hr

Maximizes room utilization through inventory awareness, stocking, cleaning of operatories, and ... Reviews patient record to consider and prepare for the complexity of each visit and /or procedure ...

Woods Oviatt Gilman LLP

Legal Assistant

Rochester, NY · On-site

$20 - $30/hr

Anticipate attorney needs by reviewing calendars and preparing necessary documents for client ... Urgency Assessment and System Utilization * Assess the urgency of situations, determine appropriate ...

University of Rochester

Dental Assistant

Rochester, NY

$20.30 - $27.41/hr

Maximizes room utilization through inventory awareness, stocking, cleaning of operatories, and ... Reviews patient record to consider and prepare for the complexity of each visit and/or procedure ...

University of Rochester

Dental Assistant

Rochester, NY · On-site

$20.30 - $27.41/hr

Maximizes room utilization through inventory awareness, stocking, cleaning of operatories, and ... Reviews patient record to consider and prepare for the complexity of each visit and/or procedure ...

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Showing results 21-40

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

Utilization Review Assistant information

See Rochester, NY salary details

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How much do utilization review assistant jobs pay per hour?

As of Aug 24, 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?

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 does a utilization review assistant do?

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 skills and qualifications are needed to be a utilization review assistant?

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.

How do I get into a utilization review assistant?

To become a utilization review assistant, candidates typically need a high school diploma or equivalent, with some roles preferring healthcare-related certifications or experience. Strong organizational skills, attention to detail, and familiarity with medical records and insurance processes are important; some positions may require knowledge of healthcare management software. Gaining relevant experience or certifications can improve job prospects in this field.

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
Infographic showing various Utilization Review Assistant job openings in Rochester, NY as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $60,159 per year, or $28.9 per hour.

RN - Nurse, Quality Assurance - Rochester NY

HCR Home Care

Rochester, NY • On-site

$77K - $92K/yr

Full-time

Re-posted 16 days ago

HCR Home Care rating

6.2

Company rating: 6.2 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

NYS Registered Nurse professional license is require for this opportunity

Role and Responsibilities

The Home Care Quality Assurance (QA) Specialist is responsible for monitoring, evaluating, and improving the quality of care delivered by the home health agency. This role ensures compliance with CMS Conditions of Participation, State regulations, Star Ratings, Value-Based Purchasing (VBP), and internal quality standards. The QA Specialist collaborates with clinical leadership to analyze data, identify performance gaps, provide staff education and drive continuous quality improvement initiatives.

Essential Functions

Quality Monitoring & Auditing

  • Conduct routine and targeted audits of clinical records for utilization review to ensure accuracy, completeness, and regulatory compliance
  • Review OASIS documentation for clinical accuracy and impact on Star Ratings and VBP measures
  • Ensure compliance with CMS, state, and accrediting body requirements
  • Identify trends, deficiencies, and opportunities for improvement
  • Assist with processing of workflow as requested
  • Perform audits and identify trends related to hospitalizations

Education & Staff Support

  • Provide feedback and education to clinicians (1:1 or group settings) regarding documentation best practices and quality standards
  • Assist with development and delivery of quality-focused education and training programs
  • Serve as a resource for staff related to quality measures, compliance, and performance outcomes
  • Remain up to date on industry changes and maintain certifications

Collaboration & Communication

  • Work closely with clinical leadership, clinical education, operations, and intake staff to improve patient outcomes and ensure clinical documentation is up to date with best practice standards and regulatory requirements
  • Communicate quality findings clearly and professionally to interdisciplinary teams
  • Participate in quality meetings and performance review discussions
  • Other duties as assigned.

This job description reflects management’s assignment of essential functions; and nothing in this herein restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

Qualifications and Requirements

Required

  • Licensed clinician (RN preferred; PT, OT, or other licensed home health clinician considered)
  • Minimum of 2–3 years of home health experience
  • Strong knowledge of OASIS, CMS regulations, and home health quality measures
  • Experience with clinical documentation review and audits
  • Strong analytical, organizational, and communication skills
  • Computer literacy and experience with Microsoft Office
  • Must have current, valid driver’s license and reliable transportation.
  • Attention to detail
  • Data-driven decision-making
  • Continuous improvement mindset

Preferred

  • Quality, compliance, or QAPI experience in home health
  • Familiarity with EMR systems (HCHB) and quality reporting tools (SHP)
  • Certification in healthcare quality or compliance (e.g., HCS-D, COS-C, or similar)

Work Environment

The Quality Assurance Specialist is primarily in an office setting and may be exposed to outdoor conditions.

The working conditions are classified as sedentary work:

  • Sedentary work - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.
  • Occasional travel to branch offices or field staff meetings is required

Physical Requirements

The following is a description of the physical requirements on a daily basis for the Quality Assurance Specialist. While performing the duties of the job the employee is regularly expected to:

  • Stand
  • Sit
  • Hear
  • Walk
  • Talk
  • Stoop or kneel
  • Repetitive motion

This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed as assigned.


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