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Utilization Review Case Manager Jobs in Rochester, NY

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Utilization Review Case Manager information

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How much do utilization review case manager jobs pay per hour?

As of Jun 12, 2026, the average hourly pay for utilization review case manager in Rochester, NY is $36.00, according to ZipRecruiter salary data. Most workers in this role earn between $29.18 and $37.93 per hour, depending on experience, location, and employer.

What are some common challenges Utilization Review Case Managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a Utilization Review Case Manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as a Utilization Review Case Manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Rochester, NY? For Utilization Review Case Manager jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Rochester, NY look for? The top searched job categories for Utilization Review Case Manager jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Utilization Review Case Manager jobs? Cities near Rochester, NY with the most Utilization Review Case Manager job openings:
Utilization Review Case Manager jobs near you

Registered Nurse - Utilization Review - RNSC

NavitasPartners

Rochester, NY

$60/hr

Full-time, Contractor

Posted yesterday

Job description

Registered Nurse (RN) – Utilization Review

Location: Syracuse, NY

Job Type: 14-Week Contract | Traveler or Local

Shift: Day Shift (Monday–Friday)

Hours: 8 Hours Per Day

Pay Rate: $60 - $65/hour

Position Overview

We are seeking an experienced Registered Nurse (RN) with Utilization Review and acute care experience to support medical necessity reviews, regulatory compliance, and care coordination activities. The RN will collaborate with physicians, case managers, insurance providers, and interdisciplinary teams to ensure appropriate utilization of healthcare services while promoting quality and cost-effective patient care.

Requirements

  • Active New York State Registered Nurse (RN) License required.

  • Current BLS Certification required or ability to recertify.

  • Minimum 1.5 years of recent acute care hospital experience required.

  • Utilization Review, Utilization Management, or Case Management experience strongly preferred.

  • Familiarity with InterQual and/or MCG criteria required or strongly preferred.

  • Knowledge of CMS regulations related to hospital admissions and inpatient criteria required.

  • Experience working with healthcare payers and regulatory agencies preferred.

  • EPIC EMR experience preferred.

  • Strong analytical, communication, and documentation skills.

  • Clean professional license history with no suspensions, investigations, or malpractice claims.

  • Must pass all required health, drug screening, and background check requirements.

Responsibilities

  • Conduct clinical reviews for inpatient admissions and continued stay authorization.

  • Apply InterQual, MCG, and evidence-based criteria for medical necessity determinations.

  • Review patient charts and clinical documentation for appropriateness of care.

  • Collaborate with physicians, case managers, and interdisciplinary teams.

  • Communicate with insurance companies, payers, and regulatory agencies regarding authorization decisions.

  • Support discharge planning and appropriate level-of-care transitions.

  • Ensure compliance with CMS regulations and hospital policies.

  • Document utilization review decisions accurately and timely in EMR systems.

Certification & Licensure

  • New York State Registered Nurse (RN) License

  • Basic Life Support (BLS)

Preferred Qualifications

  • Experience with InterQual and/or MCG Criteria

  • Prior Utilization Management or Case Management Experience

  • EPIC EMR Experience

  • Experience Working with Insurance Payers and Regulatory Agencies

Facility Highlights

  • Acute Care Hospital Environment

  • Collaborative Case Management and Utilization Review Department

  • Focus on Regulatory Compliance and Efficient Patient Flow

  • Strong Interdisciplinary Team Structure

For More Details

Email: hdavda@navitashealth.com
Call/Text: 516-862-1169

About Navitas Healthcare, LLC

It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.