ZipRecruiter

Log In

1

Utilization Review Manager Jobs in Rochester, NY

next page

Showing results 1-20

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

Utilization Review Manager information

See Rochester, NY salary details

$38.5K

$89.8K

$165.3K

How much do utilization review manager jobs pay per year?

As of Jun 21, 2026, the average yearly pay for utilization review manager in Rochester, NY is $89,798.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $108,000.00 per year, depending on experience, location, and employer.

What jobs pay $2000 a day?

Utilization Review Managers typically do not earn $2000 a day; such high daily rates are more common in specialized consulting, executive roles, or highly paid medical professionals. Most jobs with daily earnings of this level require extensive experience, certifications, or work in high-demand industries like finance, law, or executive management.

What are some common challenges faced by Utilization Review Managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

What job makes $10,000 a month without a degree?

A Utilization Review Manager can potentially earn around $10,000 per month, especially with extensive experience and certifications in healthcare management or medical review. These roles typically require strong analytical skills, knowledge of medical billing and coding, and the ability to oversee utilization review processes in healthcare settings. While a degree can be helpful, some professionals advance through experience and industry certifications such as Certified Professional in Healthcare Quality (CPHQ).

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

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What jobs in the US pay 300,000 a year?

Utilization Review Managers in healthcare or insurance industries can earn around $300,000 annually with extensive experience, advanced certifications, and leadership responsibilities. High-paying roles often require strong analytical skills, knowledge of medical billing and coding, and proficiency with healthcare management software. Executive-level positions in healthcare organizations may also reach or exceed this salary level.

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

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What does a utilization review manager do?

A utilization review manager oversees the process of evaluating medical services to ensure they are necessary, appropriate, and cost-effective. They coordinate with healthcare providers, review patient records, and ensure compliance with insurance and regulatory standards, often using specialized software. This role requires strong analytical skills and knowledge of healthcare policies and insurance guidelines.
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 Manager jobs in Rochester, NY? For Utilization Review Manager jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Rochester, NY look for? The top searched job categories for Utilization Review Manager jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Utilization Review Manager jobs? Cities near Rochester, NY with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you

Registered Nurse - Utilization Review - RNSC

NavitasPartners

Rochester, NY • On-site

$60/hr

Other

Posted 11 days ago

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.

Apply