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Utilization Review Manager Jobs in Rochester, NY

Lthc

Pharmacy Prior Authorization Technician

Rochester, NY · On-site

$17.25 - $21/hr

... a utilization management pharmacist to support Plan members in after hour pharmacy issues. Essential Accountabilities: * Review of medical exception requests based on algorithms created by ...

New

Lthc

Pharmacy Prior Authorization Technician

Rochester, NY · On-site

$17.25 - $21/hr

... a utilization management pharmacist to support Plan members in after hour pharmacy issues. Essential Accountabilities: * Review of medical exception requests based on algorithms created by ...

New

Lthc

Pharmacy Prior Authorization Technician

Rochester, NY · On-site

$17.25 - $21/hr

... a utilization management pharmacist to support Plan members in after hour pharmacy issues. Essential Accountabilities: * Review of medical exception requests based on algorithms created by ...

New

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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 Sep 11, 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 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 key skills and qualifications needed to thrive as a utilization review manager?

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 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 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.

How much does a utilization review manager make?

A utilization review manager typically earns between $70,000 and $110,000 annually, depending on experience, location, and the size of the organization. They often require knowledge of healthcare policies, insurance processes, and may hold certifications such as URAC or CCM.

Is utilization review manager a stressful job?

Utilization review managers often work in a fast-paced healthcare environment, which can be stressful due to the need to meet strict deadlines, ensure accurate assessments, and handle complex cases. The role requires strong organizational skills and attention to detail, and some individuals may find the responsibility and workload challenging, especially during high-volume periods.

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
Infographic showing various Utilization Review Manager job openings in Rochester, NY as of September 2026, with employment types broken down into 94% Full Time, and 6% Part Time. Highlights an 88% In-person, 4% Hybrid, and 8% Remote job distribution, with an average salary of $89,798 per year, or $43.2 per hour.

Nurse Navigator - Family Planning Clinic

Rochester, NY • On-site

Rochester Regional Health
Hospitals • 10K+ employees
Learn more about Rochester Regional Healthexternal

Full-time

Posted 9 days ago

Rochester Regional Health rating

7.3

Company rating: 7.3 out of 10

Based on 222 frontline employees who took The Breakroom Quiz

Job description

Job Title: Nurse Navigator - Family Planning Clinic
Location: St. Mary's OBGYN - 65 Genesee St Ste 3, Rochester, NY 14611
Hours Per Week: 40
Schedule: Monday-Friday 8am-4pm
SUMMARY
Provides proactive case coordination/patient navigation for patients, including triage management, algorithm management, utilization management and resource management. Organizes services across the continuum from pre-registration through discharge from the Center to affect optimal patient outcomes, achieve continuity and quality of care, reduces cost and provide customer satisfaction. Provides assistance to patients and families through evaluation of social, emotional and financial needs and coordinates and facilitates appropriate resources. Communicates with third party payors, follows Health System policies and procedures, and assist with continually improving the quality and effectiveness of case management/patient navigation.
RESPONSIBILITIES
  • Reviews the medical record with referring provider as soon as possible after admission-within the first 12 to 24 hours. Applies utilization review criteria to assess and document appropriateness of admission, continued stay and level of care.
  • Interviews patients and/or family members to obtain information about social, emotional, and financial factors which impact health status. Assesses needs for progress along department algorithm of care and continuing care or resource support following discharge.
  • Responds to referrals from patients, families, physicians, hospital staff, and community agencies. Collaborates with patient/family and members of health care team to develop appropriate post-hospital plans for continuing care or resource support following discharge. Utilize all appropriate medical, social, and financial resources available to support the patient/family and to ensure smooth transition to appropriate levels of care.
  • Responds to referrals from patients, families, physicians, hospital staff, and community agencies. Collaborates with patient/family and members of health care team to develop appropriate post-hospital plans for continuing care, to initiate referrals.
  • Proactively identifies problems with utilization of resources and assures specific tests, consults etc. are done in a timely manner. Feedback is obtained and documented in the patient chart. Forward patient chart to physician for review when problems are identified. Intercedes with appropriate department or attending physician to identify cause. Communicates as needed with Physician Advisor, assures patient is placed on clinical pathway and monitors variances from pathway as appropriate.
  • Maintains current information on community resources, third party payors, and managed care environment. Knowledgeable of changing rules/regulations, and policies/procedures. Maintains established departmental policies and procedures, objectives, quality management plan, environmental and infection control standards.
  • Maintains appropriate and timely documentation through medical record entries, daily logs, computer entries, and monthly statistics. Prepares and maintains required documentation on each patient.
  • Completes worksheets, communicates in a timely manner with physicians and coders, provides necessary statistics for data collection, and identifies case mix issues.
  • May provide consultation and education to medical and hospital staff of inpatient and outpatient programs regarding role of case management. This may include appropriate management of resources, discharge planning and complex medical/legal issues.
  • Assists in development of new services or policies appropriate to patient needs and consistent with strategic plan
  • Makes referrals to administrative director, medical director, quality management, risk management, infection control, and hospital departments when potential quality problems are identified. Refers to and consults with clinical social worker on patients with complex psychosocial/financial needs. Develops and maintains professional working relationship with medical staff, hospital staff, and coworkers.
  • Maintains strict confidentiality at all times.
  • Ensures that quality of patient care is maintained by collecting quality indicators and clinical path variance data, as well as identifying data that indicates potential areas for improvement. Participates actively on clinical pathway, CQL, and clinical process improvement teams. May act as team member, team leader, facilitator, or recorder.
  • Provides services, supports or other assistance in a culturally sensitive manner responsive to the patient/families beliefs, attitudes, language and behaviors.
  • Provides care appropriate to each patient.
  • Develop and maintain strong working relationships with all key internal stakeholders including physicians and center leadership.
  • Ensure strict adherence to all established Unity processes, procedures and standards.

REQUIRED QUALIFICATIONS
  • Graduate of an approved school of nursing, BSN preferred.
  • Minimum of five years of experience in a health care setting, of which a minimum of two years has been spent in acute care setting.
  • Current licensure as an RN in the state of New York.

PREFERRED QUALIFICATIONS
  • Prior experience in women's health strongly preferred.

EDUCATION:
AS: Nursing (Required)
LICENSES / CERTIFICATIONS:
BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - NYS Office of Professions
PHYSICAL REQUIREMENTS:
Light - Clinical - Light clinical roles involve frequent standing and walking, with occasional lifting of light objects (≤20 lbs.) and routine reaching, grasping, and fine manipulation for tasks such as patient care, laboratory work, or specimen processing. Staff rely on strong visual and auditory acuity to accurately observe specimens, read instrumentation, monitor patients, respond to alarms, and communicate effectively with care teams. Cognitive demands include multitasking, prioritizing clinical and laboratory workflows, and coordinating with interdisciplinary teams. Emotional resilience is necessary due to frequent interruptions, shifting priorities, and the need for precise and compassionate interaction with patients and colleagues. Environmental exposures may include infectious materials, biological specimens, cleaning agents, sharps, chemical reagents, and wet surfaces. PPE use, TB testing, and schedule flexibility are commonly required.
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:
$80,753.00 - $110,292.00
CITY:
Rochester
POSTAL CODE:
14611
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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