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Utilization Review Coordinator Jobs in Rochester, NY

pcscco

Care Coordinator

Newark, NY

$19.25 - $26/hr

This review must occur during a face-to-face meeting, no less than annually. * Accountable for coordinating all aspects of an individual's care. * Effectively manage a tiered caseload, while ...

Person Centered Services

Care Coordinator

Newark, NY · On-site

$19.25 - $26/hr

This review must occur during a face-to-face meeting, no less than annually. * Accountable for coordinating all aspects of an individual's care. * Effectively manage a tiered caseload, while ...

Person Centered Services

Care Coordinator

Newark, NY · On-site

$24/hr

This review must occur during a face-to-face meeting, no less than annually. * Accountable for coordinating all aspects of an individual's care. * Effectively manage a tiered caseload, while ...

Nascentia Health

MLTC Care Coordinator

Rochester, NY · On-site

$20 - $25/hr

Care Coordinator I Syracuse, NY Office I Rome, NY Office I Rochester, NY Office Supporting Seamless ... Review, process, and enter authorization data accurately into computerized systems * Monitor and ...

Nascentia Health

MLTC Care Coordinator

Rochester, NY · On-site

$20 - $25/hr

Care Coordinator I Syracuse, NY Office I Rome, NY Office I Rochester, NY Office Supporting Seamless ... Review, process, and enter authorization data accurately into computerized systems * Monitor and ...

Nascentia Health

MLTC Care Coordinator

Rochester, NY · On-site

$20 - $25/hr

Care Coordinator I Syracuse, NY Office I Rome, NY Office I Rochester, NY Office Supporting Seamless ... Review, process, and enter authorization data accurately into computerized systems * Monitor and ...

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Utilization Review Coordinator information

See Rochester, NY salary details

$15

$29

$46

How much do utilization review coordinator jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for utilization review coordinator in Rochester, NY is $29.21, according to ZipRecruiter salary data. Most workers in this role earn between $21.11 and $34.13 per hour, depending on experience, location, and employer.

How does a utilization review coordinator collaborate with healthcare providers and insurance companies?

A Utilization Review Coordinator regularly communicates with both healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. They review medical records and treatment plans, discuss cases with physicians to clarify medical necessity, and submit documentation to insurance payers for approval. This role requires strong interpersonal skills, as coordinators often need to negotiate coverage decisions and resolve discrepancies between clinical teams and insurers. Effective collaboration ensures timely authorizations and helps avoid unnecessary delays in patient care.

What degree do I need for utilization review coordinator?

A utilization review coordinator typically needs at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Relevant certifications, such as Certified Professional Coder (CPC) or Certified Utilization Review Professional (CURP), can enhance job prospects. Strong knowledge of medical terminology, insurance processes, and healthcare regulations is also important.

What does a utilization review coordinator do?

A Utilization Review Coordinator is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and regulatory requirements. By coordinating between healthcare providers, insurance companies, and patients, Utilization Review Coordinators help optimize resource use and manage healthcare costs while ensuring quality patient care.

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

AspectUtilization Review CoordinatorUtilization Review Nurse
CredentialsTypically requires a healthcare-related certification or associate degreeRegistered Nurse (RN) license required
Work EnvironmentOffice setting, administrative tasks, coordinationClinical setting, patient chart review, direct communication with healthcare providers
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Common Search & ComparisonFocuses on administrative review processesInvolves clinical assessment and patient care considerations

While both roles involve reviewing healthcare utilization, the Utilization Review Coordinator primarily handles administrative and coordination tasks, often without direct patient contact, whereas the Utilization Review Nurse performs clinical assessments as a licensed RN, often in hospital or clinical settings. Understanding these differences helps job seekers identify the right role based on their credentials and career goals.

What skills and qualifications are needed to be a utilization review coordinator?

To thrive as a Utilization Review Coordinator, you need expertise in healthcare regulations, clinical guidelines, and case management, often supported by an RN license or a background in health administration. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance approval processes are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills ensure compliance, optimize resource use, and support quality care delivery within healthcare organizations.

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 Coordinator jobs in Rochester, NY?

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

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

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

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

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

Utilization Review Coordinator jobs near you
Infographic showing various Utilization Review Coordinator job openings in Rochester, NY as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $60,764 per year, or $29.2 per hour.

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

Rochester Regional Health

Newark, NY • On-site

Full-time

Re-posted 20 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

305th of 887 rated healthcare providers

Job description

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.
STATUS: Full-Time
LOCATION: Rochester Regional Health Home Care - Newark
DEPARTMENT: HHC CHHA NE REGION NURSING
SCHEDULE: Monday-Friday, 8:00am-4:00pm
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

ATTRIBUTES
  • Level I -1 year of nursing experienced preferred.
  • Prior home health, clinical and direct patient care experience preferred.
  • Ability to work independently.
  • Demonstration of solid interpersonal, organizational and time management skills.
  • Proficient computer skills.
  • Must be able to document clinical notes and assessments within an electronic medical record.
  • Ability to travel to and from required locations as needed to perform the essential responsibilities of the job.
  • Level II - requires similar qualifications as level I, plus:
  • Understands when to escalate to management.

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.
  • Consistently demonstrates high standards of integrity by supporting the Rochester Regional Health Companies' mission and values and adhering to the Corporate Code of Conduct.
  • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Regular and reliable attendance is expected and required.
  • Performs other job-related duties as assigned by management.

REQUIRED QUALIFICATIONS
  • Diploma or Associate's Degree in Nursing required
  • Registered Nurse license in New York State.
  • Valid NYS Driver's License.

PREFERRED QUALIFICATIONS
  • Bachelor's Degree in Nursing preferred.

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:
Newark
POSTAL CODE:
14513
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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