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Utilization Review 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 · 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 ...

Mvphealthcare

Concurrent Review - RN

Rochester, NY · Remote

$69K - $92K/yr

Ideal for experienced RNs looking to expand into utilization management, this position provides ... Reviews inpatient medical records against established criteria and standards to determine medical ...

Lthc

Utilization Management Services Rep I

Rochester, NY · On-site

$15.75 - $21.50/hr

Summary: This position supports the Utilization Management (UM) workflows by providing ... review and creation of desk level procedures, acting as a subject matter expert for UM Services.

Lthc

Utilization Management Services Rep I

Rochester, NY · On-site

$15.75 - $21.50/hr

Summary: This position supports the Utilization Management (UM) workflows by providing ... review and creation of desk level procedures, acting as a subject matter expert for UM Services.

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · Remote

$65K - $120K/yr

... management of assigned therapists when necessary * Perform ongoing review of high-risk cases and provide clinical solutions as appropriate * Engage in the Utilization Review process for assigned ...

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · On-site

$65K - $120K/yr

... management of assigned therapists when necessary * Perform ongoing review of high-risk cases and provide clinical solutions as appropriate * Engage in the Utilization Review process for assigned ...

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All JobsUtilization Review 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 Jul 13, 2026, the average yearly pay for utilization review manager in Rochester, NY is $89,822.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $108,100.00 per year, depending on experience, location, and employer.

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 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 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 the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.
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

Health Information Management Technician 1 (NY HELPS), Rochester Psychiatric Center, P26998

StateJobsNY

Rochester, NY • On-site

$49K - $63K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 9 days ago

Job description

Duties Description As a Health Information Management Technician 1, duties include:
• Ensuring the accuracy of clinical progress notes, laboratory reports, and treatment records.
• Reviewing facility staff medical and clinical services documentation for Medicaid funding.
• Transcribing and coding medical, clinical, and mental health services.
• Maintaining databases for tracking health information disclosures.
• Providing technical assistance and support to facility and clinical staff on health information management requirements.
• Conducting audits for utilization review activities and reporting deficiencies to the Utilization Review Committee.
• Implementing corrective actions as determined by internal and external audit findings.
• May supervise lower-level clerical and support staff.
Minimum Qualifications Candidates from outside State Service can be considered for hire under the Hiring for Emergency Limited Placement - Statewide (HELPS) program if they have a current certification by the American Health Information Management Association as a Registered Health Information Administrator (RHIA) or as a Registered Health Information Technician (RHIT).
OR
Candidates from within State Service can be considered for a competitive class appointment if they have one year of permanent competitive or 55-b/55-c service in a title eligible for transfer under Section 70.1 of the Civil Service Law.
Additional Comments All OMH employees receive a generous benefits package including:
• NYS medical, dental, & vision insurance
• Access to tuition assistance programs
• Excellent opportunities for advancement & professional growth
• Paid time off - 13 paid vacation days in the first year, 5 paid personal days, 13 paid holidays, & paid sick leave
• NYS Retirement programs
Background checks will be required.
Some positions may require additional credentials or a background check to verify your identity.
Name Human Resources
Telephone
Fax 585-241-1981
Email Address rpc-human.resources@omh.ny.gov
Address
Street Rochester Psychiatric Center
1111 Elmwood Avenue
City Rochester
State NY
Zip Code 14620
Notes on Applying Indicate the Title and Location of the position you are applying for. Please complete the Office of Mental Health Employment Application and submit it with your other application materials.
https://omh.ny.gov/omhweb/employment/docs/employment-application.pdf
The Mission of the New York State Office of Mental Health is to promote the mental health of all New Yorkers, with a focus on providing hope and supporting recovery for adults with serious mental illness and children with serious emotional disturbances. Applicants with lived mental health experience are encouraged to apply. OMH is deeply committed to supporting underserved individuals, organizations, and communities. To this end, OMH is focused on implementing activities and initiatives to reduce disparities in access, quality, and treatment outcomes for underserved populations. A critical component of these efforts is ensuring OMH is a diverse and inclusive workplace where all employees' unique attributes and skills are valued and utilized to support the mission of the Agency. OMH is an equal opportunity/affirmative action employer.

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