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Utilization Review Rn Jobs in Buffalo, NY (NOW HIRING)

Kaleida Health

Director Utilization Management

Buffalo, NY · On-site

$114K - $157K/yr

Registered Nurse NYS licensure required upon hire. Certification in Case Management or Hospital ... BGMC Utilization Review Standard Hours Bi-Weekly : 0.00 Weekend/Holiday Requirement: No On Call ...

Elderwood

RN Care Manager

Buffalo, NY · On-site

$92K/yr

Participating in the utilization review process and evaluating to determine if the member ... A current New York State Registered Nurse License (Required) * A valid NYS Driver's license ...

Harris Hill Nursing Facility LLC

MDS Lead RN

Buffalo, NY

$36 - $37/hr

... utilization, and reimbursement * Assist facilities with certification procedures, reimbursement ... Collaborate with claims review units, compliance teams, and third-party payers to ensure regulatory ...

The McGuire Group

MDS Lead RN

Williamsville, NY

$36 - $37/hr

... utilization, and reimbursement * Assist facilities with certification procedures, reimbursement ... Collaborate with claims review units, compliance teams, and third-party payers to ensure regulatory ...

McGuire

MDS Lead RN

Williamsville, NY · On-site

$36 - $37/hr

... utilization, and reimbursement * Assist facilities with certification procedures, reimbursement ... Collaborate with claims review units, compliance teams, and third-party payers to ensure regulatory ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Buffalo, NY

Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Jul 19, 2026, the average hourly pay for utilization review rn in Buffalo, NY is $40.96, according to ZipRecruiter salary data. Most workers in this role earn between $32.36 and $47.02 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Buffalo, NY? The most popular types of Utilization Review Rn jobs in Buffalo, NY are:
What are popular job titles related to Utilization Review Rn jobs in Buffalo, NY? For Utilization Review Rn jobs in Buffalo, NY, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Buffalo, NY look for? The top searched job categories for Utilization Review Rn jobs in Buffalo, NY are:
What cities near Buffalo, NY are hiring for Utilization Review Rn jobs? Cities near Buffalo, NY with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Buffalo, NY as of July 2026, with employment types broken down into 11% As Needed, 78% Full Time, and 11% Part Time. Highlights an 100% In-person job distribution, with an average salary of $85,191 per year, or $41 per hour.
Registered Nurse Utilization Review SCH

Registered Nurse Utilization Review SCH

Catholic Health System

Buffalo, NY

$75K - $113K/yr

Full-time

Re-posted 15 days ago

Catholic Health rating

7.9

Company rating: 7.9 out of 10

Based on 177 frontline employees who took The Breakroom Quiz

105th of 886 rated healthcare providers

Job description

Facility: Sisters of Charity Hospital
Shift: Shift 1
Status: Full Time FTE: 1.000000
Bargaining Unit: ACE Associates
Exempt from Overtime: Exempt: Yes
Work Schedule: Days with Weekend and Holiday Rotation
Hours:
8am -4 pm
Summary:
The Registered Nurse (RN), Utilization Review, as an active member of the Middle Revenue Cycle and interdisciplinary care team, provides comprehensive Utilization Review to patients and families in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with the interdisciplinary team to maintain appropriate levels of care and to facilitate movement of the patient through the continuum. The Utilization Review RN identifies and removes barriers for delays of treatment. This individual also works to maintain third-party payer relationships related to Utilization Review Activities. This includes, but is not limited to, concurrent review, responding to inquiries, complaints, and other correspondence, and may include setting up discussions between parties. Knowledge of state and federal laws relating to contracts and utilization review process processes is vital.
Responsibilities:
EDUCATION
  • BSN degree or RN with a BS in health-related field and working knowledge/experience in documentation utilization review in an acute care/inpatient setting
  • Unrestricted NYS RN license
  • Holds, or will obtain within one year of hire, Certified Case Manager (CCM)
  • Certification in a Nationally Recognized Utilization Review Criteria set is preferred
  • At least one (1) year of experience in working with third party payers strongly preferred

EXPERIENCE
  • Minimum of three (3) years of experience working in an Acute Care Hospital Setting
  • Proficiency in utilization management and regulatory requirements preferred
  • Experience in working with people who are geographically dispersed preferred
  • Experience in working with third party payers strongly preferred

KNOWLEDGE, SKILL AND ABILITY
  • Strong clinical assessment skills and ability to articulate findings in a fast-paced environment. Possess the ability to make independent decisions within the professional scope of practice
  • Possess ability to educate, inform, advocate, promote and facilitate health care options, and demonstrate the willingness to work harmoniously with a team approach
  • Possesses ability to effectively and efficiently utilize technology within daily work with the care team and ability to quickly learn and adapt to new technology tools and software
  • Extensive knowledge of third-party payer guidelines, accreditation and regulatory requirements preferred
  • Knowledge of Managed Care Organization contracts/agreements preferred

WORKING CONDITIONS
  • Willingness to work beyond normal working hours, and in other positions temporarily, and/or at other locations when necessary
  • Variable schedule which may include weekends and holidays. May be requested to travel to multiple hospital and community sites

ENVIRONMENT
  • Normal heat, light space, and safe working environment; typical of most office jobs
  • Occasional exposure to one or more mildly unpleasant physical conditions
  • Minimum physical effort required, typical of most office work
  • Significant amount of walking within the acute care facility

What Catholic Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Catholic Health

Sourced by ZipRecruiter

Formed in 1998 under four religious sponsors, Catholic Health in Buffalo, NY is a non-profit healthcare system that provides care to Western New Yorkers across a network of hospitals, nursing homes, home care agencies, physician practices, and other community based ministries. Today, the system has two religious sponsors, the Diocese of Buffalo and the Franciscan Sisters of St. Joseph, who carried on its Mission across the Buffalo-Niagara region. Our mission sets us apart. It's the human side of healthcare – the touch, smile or comforting word that can help make your healthcare experience better. It's treating all people with respect and dignity, and providing comfort in times of greatest need. Catholic Health is making the largest investment in its history, dedicating more than $100 million in state-of-the- art technology that will connect our hospitals, home care, long-term care, clinician offices, health centers and ancillary services with patients throughout the area. This transformational investment marks a major milestone for our healing ministry, which dates back more than 165 years.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Buffalo, NY, US

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