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Utilization Review Case Manager Jobs in Rochester, NY

Lthc

Medical Director, Commercial

Rochester, NY

Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical services ...

Lthc

Medical Director, Commercial

Rochester, NY · On-site

Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical services ...

Lthc

Medical Director, Commercial

Rochester, NY

Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range of medical services ...

Highland Hospital

RN Case Manager PC/FM

Rochester, NY

$37 - $45/hr

18247BR Title: RN Case Manager PC/FM Department/Cost Center: 891 - Highland Family Medicine Under ... utilization management, proactive patient management, care facilitation and treatment planning ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Rochester, NY

Utilization Review Case Manager information

See Rochester, NY salary details

$16

$35

$59

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

As of Jun 14, 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

Case Manager - Permanency Resource Center

Catholic Charities Finger Lakes

Newark, NY • On-site

$22/hr

Full-time

Retirement

Posted 19 days ago

Job description

Job Type
Full-time
Description
We are Hiring!
Job Posting: Case Manager - Permanency Resource Center
Location: 180 East Union Street, Newark, NY
Department: TRPC
Employment Type: Full-Time
Salary: $22.00 An Hour
As a regional agency of Catholic Charities of the Diocese of Rochester, Catholic Charities of the Finger Lakes serves Ontario, Wayne, Seneca, Cayuga, and Yates Counties with quality human service programs and advocating for social justice. We work with community partners to meet human needs and affect public policy that addresses the needs of all people. Together we make our community stronger, safer, and more inclusive.
If you're looking for an opportunity to express and explore your passion for helping others, then join a team that truly makes a difference DAILY, in people's lives. Don't miss out on being a part of something special!
General Description
The Case Manager serves families with an adopted child or those that have become guardians of a relative's child, providing supportive services and connecting families to resources such as parent training, peer support, mentoring, navigation for cross-system needs, therapeutic services referrals, counseling, respite care or other supports to help families address issues as they arise. The Case Manager will exercise casework assessment skills and considerable independent judgment, decision making, and creativity in assisting the individual's/family's personal growth and development while enhancing the stability of their social network.
Essential Duties and Responsibilities
  • Identify innovative means of outreach to parents, courts, law community and other key partners.
  • Provide in-home, community, or in-office skills training to parents that include appropriate methods of discipline, coping, communication skills, and child development; in addition to household financial management skills, transition management, post trauma care and more.
  • Provide outreach in the community to address trends, community needs and to maintain up to date information regarding successes, participation, family stability and general community knowledge/awareness information.
  • Maintain statistical information and complete reporting as necessary.
  • Complete intakes, determine eligibility, review individual's cases, assess situation and make appropriate referrals to contact agencies, community resources and inter agency departments as needed.
  • Completes strength based assessments and needs analysis with individual/family.
  • In collaboration with client(s), create client action plans, conduct case reviews and participate in client- based meetings.
  • Establish and maintain contact with other community services to improve ability to link clients when necessary.
  • Stay up-to-date on community resources and services that can benefit parents and children in the program.
  • Conduct follow up with clients to assure progress with goal plans.
  • Participate in staff meetings and other agency-related meetings/events.
  • Participate in agency's strategic planning efforts.
  • Complete required agency and program reports in a timely manner.
  • Perform other related duties as required/requested.

Note: The above description is illustrative of tasks and responsibilities. It is not meant to be all inclusive. Employees are required to follow appropriate supervisory direction and perform other related duties as required.
#INSJ
Requirements
Qualifications
Education:
Bachelor's degree in Social Sciences or Social Work
Experience:
At least 2 years of related experience
Experience in child welfare, adoption and or family court systems.
Experience with Community-Based Service and Home Visits preferred
Relevant years of experience and education will be considered
Additional Qualifications:
  • Daytime travel with mileage reimbursement within Seneca, Yates, and Ontario Counties.
  • Ability to analyze and interpret data and to handle problem resolution.
  • Possession of a valid NYS Driver's license and a driver's record considered acceptable by agency and insurance carrier.
  • Continuous use of a reliable, registered and insured vehicle.
  • Willing to travel and to attend evening meetings
  • Ability to prioritize assignments, plan, and complete work projects with minimal direction
  • Exceptional time management skills and ability to effectively and meet deadlines
  • Excellent verbal/written skills
  • Ability to work in the following software programs: Windows, Microsoft Office, and multiple online software platforms as required by funders and partner organizations
  • Ability to maintain confidentiality and handle confidential information with discretion
  • Ability to demonstrate behaviors and attitudes which support organizational mission, philosophy, and policies
  • Ability to work in a cooperative and helpful manner with all individuals
  • Willingness and ability to foster agency and program wide cooperation and teamwork through use of positive/constructive communication techniques
  • Any offer of employment will be contingent upon successful completion of a background check. CCDOR considers all background check information in accordance with applicable law.

Top Benefits and Perks:
  • Competitive salary and 403b retirement plan
  • Generous time off package and work-life balance
  • Comprehensive benefits package
  • Supportive and collaborative environment
  • Opportunities for growth and development
  • Intrinsic reward of truly making a difference in people's lives

Join us and help make a positive impact in our community!
***Catholic Charities is committed to leveraging the talent of a diverse workforce to create great opportunities for our agency and our people. EOE/AA Disability/Vet
Salary Description
$22.00

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