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

Lthc

Manager, Data Platforms Admin

Rochester, NY · On-site

This role reviews in-progress and completed work for completeness, quality, and adherence to ... Uses project management tools for effective personnel utilization, to track and report progress ...

Lthc

Manager, Data Platforms Admin

Rochester, NY · On-site

This role reviews in-progress and completed work for completeness, quality, and adherence to ... Uses project management tools for effective personnel utilization, to track and report progress ...

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

Utilization Review Salary information

See Rochester, NY salary details

$21

$41

$68

How much do utilization review salary jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for utilization review salary in Rochester, NY is $41.72, 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 some common challenges utilization review professionals face in balancing patient advocacy with cost management?

Utilization Review professionals often navigate the delicate balance between ensuring patients receive appropriate care and managing healthcare costs for providers and insurers. One common challenge is interpreting complex medical records to make fair, evidence-based decisions while also adhering to strict guidelines and insurance policies. Additionally, communicating denial decisions to providers or patients requires tact and empathy. Staying current with constantly evolving regulations and medical standards is also essential to perform the role effectively.

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 valid RN license, clinical experience, and strong knowledge of medical coding and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically required. Excellent analytical thinking, attention to detail, and effective communication skills help professionals excel in this role. These capabilities are crucial for making accurate coverage decisions, ensuring compliance, and facilitating high-quality, cost-effective patient care.

What is the average salary for a utilization review nurse?

The average salary for a Utilization Review Nurse in the United States typically ranges from $65,000 to $85,000 per year, depending on factors such as experience, education, location, and employer. Major metropolitan areas and hospitals may offer higher compensation, while remote or rural locations might pay less. In addition to base salary, some positions may offer benefits like health insurance, retirement plans, and bonuses. It's important to research the specific employer and geographic region for the most accurate salary information.

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

AspectUtilization Review SalaryCase Manager Salary
Required CredentialsRN, LPN, or other healthcare certificationsRN, social work, or healthcare-related certifications
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Employer & Industry UsageUsed mainly in insurance and healthcare review settingsUsed across healthcare, social services, and insurance sectors

Utilization Review Salary and Case Manager Salary share similar credentials and work environments, often within healthcare and insurance industries. While utilization review focuses on evaluating medical necessity and appropriateness of care, case managers coordinate patient care and support. Both roles require healthcare or social work certifications, but their primary functions differ, with utilization review emphasizing review processes and case management emphasizing patient advocacy and coordination.

What degree do I need for utilization review?

Utilization review professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Many employers prefer candidates with a background in nursing or healthcare management, and some roles may require licensure or certification such as the Certified Professional in Healthcare Quality (CPHQ).

What are popular job titles related to Utilization Review Salary jobs in Rochester, NY?

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

What job categories do people searching Utilization Review Salary jobs in Rochester, NY look for?

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

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

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

Utilization Review Salary jobs near you
Infographic showing various Utilization Review Salary job openings in Rochester, NY as of June 2026, with employment types broken down into 86% Full Time, 12% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.

Supervisor (RN)Nursing Home Surveyor/Complaint Investigator

ISLAND PEER REVIEW CORP

Rochester, NY • On-site

$109K - $115K/yr

Full-time

Re-posted 29 days ago

Job description

In this Supervisor role you will assist IPRO’s Senior Director and the New York State Department of Health (NYSDOH), Office of Aging and Long-Term Care, Long Term care, with oversight of surveillance and investigation activities related to nursing homes (long term care). These activities are mandated to evaluate facility performance and monitor the quality of care and services provided. Duties include but are not limited to ensuring the quantity and quality of IPRO staff work output with acceptable outcomes; working with IPRO’s designated staff to ensure correct invoicing are submitted for staff; coordinating and assisting in providing preceptor surveillance training to IPRO surveyors;

participating as a member of an interdisciplinary survey team and producing written documentation and draft Statements of Deficiencies (SOD); attend meetings and other duties assigned.

The position will be located at the NYS DOH lower Manhattan OR Central Islip office.

Non-travel days are based at the designated office or telecommuting, if approved.

QUALIFICATIONS:

  • Demonstrate strong interpersonal skills with the ability to facilitate positive customer satisfaction in situations that are adverse or in controversy.
  • Ability to successfully work independently with minimal supervision, as well as in a team environment.
  • Excellent written and verbal skills with the ability to communicate professionally with co-workers, supervisors, providers, medical and administrative personnel, and residents/patients.
  • Ability to translate collected information into a clear, concise, legal, and defensible document.
  • Excellent investigative and analytical skills.
  • Strong computer skills with working knowledge of Microsoft office products, and the ability to learn new programs.
  • If approved to work remotely, must have secure internet that meets the speed required to perform all work duties, must have a workspace that provides privacy for all work-related calls, and must be able to secure all work-related items when not in use.
  • Must have a valid driver’s license & the ability to travel to on-site facilities review assignments.

EDUCATION & EXPERIENCE:

  • NYS Licensed, Registered Nurse, required.
  • A minimum of two (2) years of experience in performing utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities, OR, three (3) years of clinical or administrative experience, OR A bachelor’s degree in nursing and two (2) years of clinical or administrative experience and two (2) years of supervisory experience.
  • Surveyor Minimum Qualifications Test (SMQT), required.

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The salary range for this position is $109,750.00- $115,996.50. Actual salary range and /or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.

The salary range and/or hourly rate listed does not include other forms of compensation or benefits.

IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status or any other category protected under applicable law.