ZipRecruiter

Log In

1

Utilization Review Manager Jobs in Rochester, NY

DePaul

Residential Assistant

Batavia, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, assists with the case management, care and training ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, this role assists with the case management, care and ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, assists with the case management, care and training ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, this role assists with the case management, care and ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Batavia, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, assists with the case management, care and training ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY

$21 - $21.30/hr

Under the direction of the Residence Manager, assists with the case management, care and training ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, this role assists with the case management, care and ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Henrietta, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, assists with the case management, care and training ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY

$21 - $21.30/hr

Under the direction of the Residence Manager, assists with the case management, care and training ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Batavia, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, assists with the case management, care and training ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, this role assists with the case management, care and ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, this role assists with the case management, care and ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Under the direction of the Residence Manager, this role assists with the case management, care and ... Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other ...

Bonadio

Resource Manager, Assurance

Rochester, NY · On-site

$80K - $90K/yr

... review resumes for interview consideration * Collaborate with HRBP - Assurance, to identify ... Determine utilization metrics and measurements, report to the SL to hold people accountable to ...

Techgene Solutions LLC

Estimating Manager

Rochester, NY · On-site

Prepare and review detailed mechanical/plumbing estimates from schematic, design-build, and ... Advanced cost analysis, material/labor takeoffs, BIM/estimating software utilization, and contract ...

New

next page

Showing results 1-20

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 15, 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
Patient Financial Services Representative

Patient Financial Services Representative

King's Daughters

Pavilion, NY

$16.25 - $17.75/hr

Full-time

Re-posted 14 days ago

King's Daughters Health System rating

6.3

Company rating: 6.3 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

667th of 885 rated healthcare providers

Job description

At UK King's Daughters, we're not just a healthcare facility - we're a family of dedicated professionals who share a passion for making a meaningful difference in the lives of our patients. We're more than just a place to work; we're a place to grow, thrive, and contribute to our community.

Job Description:

Job Summary

Responsible for managing moderate-complexity patient account activities to optimize reimbursement and reduce accounts receivable. Provides expertise in billing, follow-up, collections, and/or denials resolution to improve financial outcomes. Ensures accuracy of charge, claim, and payment data through reviews and targeted corrections. Recommends workflow improvements, reporting insights, and queue management practices that elevate productivity. Coordinates cross-functional problem solving with coding, clinical, and payer partners to support organizational financial objectives.


Essential Functions

Provides expertise in billing, follow-up, collections, and/or denials resolution. Performs timely follow-up on outstanding claims and appeals to meet aging and recovery targets.

Reviews charge, payment, and adjustment activity to identify variances and initiate corrective action.

Reconciles patient balances and payer remittances to ensure accurate application of payments and adjustments.

Communicates professionally with stakeholders regarding estimates, statements, and complex balance questions.

Collaborates with coding, authorization, and utilization review teams to resolve documentation and coverage gaps.

Maintains compliance with HIPAA, FDCPA, and payer contract provisions in all actions.

Performs other duties as assigned.


Education Requirement: High school diploma or equivalent


Experience Requirement: 2-3 years of experience

An equivalent combination of education and experience may be considered. All experience must be paid and in the same related field. Part-time and PRN experience will be prorated based on hours worked per week. Volunteer work and internships for academic credit are not counted.


Certifications & Licensures: N/A


Working Conditions

A. Lifting, pushing, and/or pulling objects up to 50lbs:2. Occasional (< 10% of the time)

B. Lifting, pushing, and/or pulling objects over 50lbs:1. Never

C. Standing or walking with objects up to 10lbs:3. Intermittent (10% - 50% of the time)

D. Standing or walking with objects up to 25lbs:2. Occasional (< 10% of the time)

E. Sitting at the computer workstation for extended periods:3. Intermittent (10% - 50% of the time)

F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials:2. Occasional (< 10% of the time)

G. Repetitive motion:3. Intermittent (10% - 50% of the time)

H. Working at heights above 4 feet:1. Never

I. Working in confined spaces:1. Never

J. Risk of injuries from use of equipment on the job:2. Occasional (< 10% of the time)

K. Job-related travel:2. Occasional (< 10% of the time)

L. Loud noises:1. Never

M. Temperature extremes:1. Never

N. Hazardous chemicals and fumes including waste:2. Occasional (< 10% of the time)

O. Radiation:1. Never

P. Burns:1. Never

Q. Cuts/Punctures:2. Occasional (< 10% of the time)

R. Bloodborne/airborne pathogens:2. Occasional (< 10% of the time)

S. Recombinant DNA or viral vectors:1. Never

T. Combative/violent people:1. Never

U. Animal handling (including carcasses):1. Never

V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A


Physical Demands

This position requires intermittent sitting at a computer workstation for extended periods of time; performing tasks with repetitive motions (such as typing); intermittent standing or walking with objects weighing up to 10 pounds; occasional standing or walking with objects weighing up to 25 pounds; and occasional lifting, pushing, or pulling objects weighing up to 50 pounds.

Department:

Patient Financial Experience

Shift:

Days (United States of America)

Time Type:

Full time

Address:

2000 Ashland Drive

City, State:

Ashland, Kentucky

What King's Daughters Health System employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply