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Utilization Review Nurse Jobs in Rochester, NY (NOW HIRING)

Acacia Network

Program Director

Rochester, NY · On-site

$85K/yr

Perform utilization reviews, monitoring case records, ensuring compliance with all contract ... A Qualified Health Professional (CASAC; LCSW; LMSW; NP; MD; PA; Psychologist; Rehabilitation ...

Lthc

Utilization Management Services Rep I

Rochester, NY · On-site

$15.75 - $21.50/hr

... nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff ... 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

... nursing facilities, mid-level providers, members, pharmacies, pharmacists, and support staff ... review and creation of desk level procedures, acting as a subject matter expert for UM Services.

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Showing results 21-40

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

Utilization Review Nurse information

See Rochester, NY salary details

$21

$41

$68

How much do utilization review nurse jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for utilization review nurse in Rochester, NY is $41.75, according to ZipRecruiter salary data. Most workers in this role earn between $32.98 and $47.93 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a utilization review nurse, and why are they important?

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What does a utilization review nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

What does a utilization review nurse do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

How much do utilization review nurses make?

Utilization review nurses in Texas typically earn an average annual salary of around $70,000 to $85,000, depending on experience, certifications, and employer. Salaries can vary based on healthcare setting, location, and workload, with some experienced nurses earning higher wages or additional benefits.

What is the difference between Utilization Review Nurse vs Case Manager?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

More about Utilization Review Nurse jobs

What are the most commonly searched types of Utilization Review Nurse jobs in Rochester, NY?

The most popular types of Utilization Review Nurse jobs in Rochester, NY are:

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

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

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

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

Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Rochester, NY as of August 2026, with employment types broken down into 3% As Needed, 67% Full Time, 25% Part Time, and 5% Contract. Highlights an 93% In-person, and 7% Remote job distribution, with an average salary of $86,833 per year, or $41.7 per hour.

REGISTERED NURSE

Catholic Charities Family and Community Services

Brighton, NY • On-site

$35 - $38/hr

Full-time

Retirement

Re-posted 29 days ago

Job description

Job Type
Full-time
Description
We are Hiring!
Job Posting: REGISTERED NURSE
Location: Rochester, NY
Department: Nursing
Employment Type: Full time
Schedule: Monday thru Friday 8am to 4pm
Salary: $35 to $38/hr(Salaried, exempt) depending on education and experience
As a regional agency of Catholic Charities of the Diocese of Rochester, Catholic Charities Family and Community Services (CCFCS) has been serving our community for over 100 years. We walk with people when they are at their most vulnerable as they journey toward independence to reach their full human potential, advocate for those in need throughout all stages of life; and work in partnership with faith communities of all denominations and those who are committed to addressing local needs.
If you're looking for an opportunity to express and explore your passion for helping others, then join a team that truly makes a difference DAILY, in people's lives. Don't miss out on being a part of something special!
General Description
Under general supervision, provides comprehensive health services and supervision for LPN and/or Medical Liaison staff if applicable. Works collaboratively with other providers to facilitate client wellness. Maintains all applicable confidentiality and ethical standards of relevant governing bodies. Effectively supports ongoing and collaborative communication amongst all program staff and is responsible for ensuring a trauma informed care environment.
Essential Duties and Responsibilities:
  • Provides a comprehensive health assessment of clients.
  • Identifies immediate and long-term health care needs.
  • Makes appropriate referrals and recommendations based on findings of the health assessments.
  • Assists clients in identifying local resources.
  • Communicates and collaborates with appropriate Agency staff, Primary Health care provider, community justice agencies, and related community organizations to assure coordination of client care and services.
  • Completes required paperwork related to the health assessment process.
  • Provide oversight and supervision of any assigned LPN and/or Medical Liaison Staff:
  • Required supervision of tasks performed by LPN and/or Medical Liaison staff may include medication monitoring or administration, monitoring of vital signs, reporting of signs or symptoms of potential health concerns, basic emergency medical treatment or interventions.
  • Direct, coach, collaborate with and delegate tasks appropriately.
  • Build and sustains cooperative working relationships among program staff.
  • Assist in the initiation and implementation of staff development and training programs to maximize professional practice.
  • Accesses employees' skills and program needs and appropriately assign staff to meet program needs.
  • Participates in selection, hiring, and orientation of Staff.
  • Coordinates employee schedules to ensure day-to-day coverage of the Programs.
  • Reviews and approves timesheets.
  • Evaluates program effectiveness and recommends alternatives as required.
  • Assists Prescribers
  • Provide health monitoring for clients
  • Administers Injectable medications as prescribed
  • Responsible for case load records
  • Completes required case record documentation in accordance with regulations and other record keeping as necessary for program accountability
  • Participates in monthly Utilization Review, quality assurance and program evaluation activities as directed.
  • Coordinates discharge planning for clients
  • Provides education to clients on health and wellness issues.
  • Participates in staff meetings and clinical supervision as directed
  • Actively pursues development of professional competencies related to job role performance through reading, supervision, in-service training and attendance at conferences and workshops.
  • Awareness and active support of the Agency's Mission, Vision, Values and Strategic Plan. Including, but not limited to, supporting the Agency's Core Competency initiatives of being Collaborative and Community Focused, Innovative and Entrepreneurial, and Culturally Competent and Diverse

Note: The above description is illustrative of tasks and responsibilities. It is not meant to be all inclusive. Employees are required to follow appropriate supervisory direction and perform other related duties as required.
Requirements
Qualifications:
Education: Minimum of an Associate's Degree in Nursing required. Bachelor's or Master's Degree in Nursing preferred.
Credentials: Valid and clean NYS Driver's License. Valid Registered Professional Nurse (RN) License required
Experience: At least two years of experience related to nursing services to individuals with mental health, chemical dependency, substance use disorder, or intellectual/developmental disabilities-related services strongly preferred. Bi-lingual in Spanish also preferred.
Physical Demands/Work Environment: The physical demands/work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit, talk, hear, stand, walk, use hands to type and/or perform light lifting. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. The noise level in the work environment is usually quiet.
Compliance: Adheres to all applicable federal and state laws and regulations including, but not limited to, those governing confidentiality, privacy, program, billing, and documentation standards. All duties must be performed in accordance with CCFCS's corporate compliance & ethics program.
Additional Requirements:
  • Ability to prioritize assignments, plan, and complete work projects with minimal direction,
  • An ability to work efficiently and effectively and meet deadlines,
  • An ability to work under pressure,
  • Excellent verbal/written skills,
  • Ability to maintain confidentiality,
  • Ability to demonstrate behaviors and attitudes which support agency mission, philosophy, and policies.
  • Willingness and ability to foster agency and program wide cooperation and teamwork through use of positive/constructive communication techniques,
  • Possession of a valid NYS Driver's license and use of a registered and reliable vehicle.

Top Benefits and Perks:
  • Competitive salary and 403b retirement plan
  • Generous time off package and work-life balance
  • Comprehensive benefits package
  • Supportive and collaborative environment
  • Opportunities for growth and development
  • Intrinsic reward of truly making a difference in people's lives

Join us and help make a positive impact on our community!
***Catholic Charities is committed to leveraging the talent of a diverse workforce to create great opportunities for our agency and our people. EOE/AA Disability/Vet
Salary Description
$35 to $38/hr

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