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Utilization Review Jobs in Rochester, NH (NOW HIRING)

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Travel Utilization Management RN

Exeter, NH · On-site

$1.9K - $2.1K/wk

Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 36 hours per week * Shift: 12 hours * Employment Type: Travel GLC is hiring: RN Manager/Director LTC/SNF - Exeter, NH - 8 ...

LanceSoft

Travel RN Care Manager

York, ME · On-site

Must have utilization reveiw and discharge planning experience. Certification by a nationally recognized case management or utilization review organization preferred Must have active BLS. CCM or ACM ...

InstantServe LLC

RN Care Manager

York, ME · On-site

Must have utilization reveiw and discharge planning experience. Certification by a nationally recognized case management or utilization review organization preferred Must have active BLS. CCM or ACM ...

American Traveler

Travel RN Care Manager

York, ME · On-site

Utilization review and discharge planning experience required * Associate or Bachelor's degree in Nursing required Additional Information * Coordinate concurrent utilization management activities ...

The Ridge RTC

Program Manager

Milton, NH

Assisting with the discharge process while utilizing discharge tools and tracking the entire process through the EMR, while ensuring constant communication with billing and Utilization Review team ...

Prime Staffing

Travel RN Care Manager

York, ME · On-site

Certification by a nationally recognized case management or utilization review organization preferred Must have active BLS. CCM or ACM preferred. Additional Information:If timecards are not filled ...

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All JobsUtilization Review JobsUtilization Review Jobs in Rochester, NH

Utilization Review information

See Rochester, NH salary details

$20

$41

$67

How much do utilization review jobs pay per hour?

As of Jul 6, 2026, the average hourly pay for utilization review in Rochester, NH is $41.38, according to ZipRecruiter salary data. Most workers in this role earn between $32.69 and $47.50 per hour, depending on experience, location, and employer.

What jobs make $3,000 a day?

High-paying jobs that can reach $3,000 a day include specialized roles such as senior physicians, anesthesiologists, or surgeons, often requiring advanced certifications and extensive experience. Certain executive positions, like CEOs or investment bankers, may also earn this level of daily income, especially through bonuses or profit sharing. These roles typically involve high responsibility, expertise, and demanding schedules.

What jobs pay 4000 a week without a degree?

Utilization Review specialists typically do not earn $4,000 per week without a degree; most roles in this field require healthcare-related certifications or experience. High-paying jobs that can reach this level without a degree include certain sales positions, real estate brokers, or specialized trades like commercial pilots or skilled trades, which often rely on experience, licensing, or certifications rather than formal degrees. These roles may involve commission, bonuses, or overtime to achieve such weekly earnings.

What does a typical day look like for someone working in Utilization Review?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What skills do you need for utilization review?

Utilization review professionals need strong analytical skills to assess medical necessity and appropriateness of care, attention to detail, and knowledge of healthcare regulations and insurance policies. Good communication skills are essential for coordinating with healthcare providers and explaining decisions. Familiarity with electronic health records (EHR) systems and relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can also be beneficial.

What is a Utilization Review job?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What are the key skills and qualifications needed to thrive in the Utilization Review position, and why are they important?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare professional such as a registered nurse, licensed social worker, or physician completes relevant education and gains experience in healthcare or insurance. Certification in utilization review or case management, such as the Certified Professional in Healthcare Quality (CPHQ), can improve job prospects. Strong analytical skills and knowledge of medical coding and insurance policies are also important.
What are popular job titles related to Utilization Review jobs in Rochester, NH? For Utilization Review jobs in Rochester, NH, the most frequently searched job titles are:
What cities near Rochester, NH are hiring for Utilization Review jobs? Cities near Rochester, NH with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Rochester, NH as of July 2026, with employment types broken down into 1% As Needed, 73% Full Time, 21% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $86,075 per year, or $41.4 per hour.

Director, Utilization Review

Cobalt Benefits Group LLC

Exeter, NH • On-site

$135K - $155K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

Job description

Description:

The Director of Utilization Review is responsible for the strategic leadership, operational execution, and regulatory compliance of the Utilization Review (UR) program. This role ensures clinically sound, timely, and compliant medical necessity determinations across all lines of business, while driving integration across Claims, Appeals, Stop Loss, and vendor partners. The position also advances technology-enabled utilization management, interoperability, and population health strategies in alignment with CBG’s operational and client objectives.


Clinical & Operational Leadership:

  • Provide leadership and oversight of the Utilization Review department
  • Ensure consistent, evidence-based medical necessity determinations
  • Establish and enforce clinical guidelines, documentation standards, and review protocols
  • Maintain alignment with MCG guidelines and internal clinical governance standards

Claims, Appeals & Stop Loss Integration:

  • Ensure seamless alignment between UR and Claims workflows
  • Provide clinical expertise and documentation support for Appeals processes
  • Partner with Stop Loss teams on high-cost claim reviews and determinations
  • Promote end-to-end workflow efficiency across clinical and administrative functions

Regulatory Compliance & Audit Readiness:

  • Ensure compliance with CMS, state, ERISA/non-ERISA, and accreditation requirements
  • Maintain audit-ready documentation and defensible clinical decisions
  • Oversee development and accuracy of denial and determination letters
  • Partner with Compliance and Legal to ensure regulatory alignment across all lines of business

Technology, Interoperability & Data Strategy:

  • Drive automation and digital workflow enhancements within UR
  • Enable interoperability across UR, Claims, Appeals, and vendor systems
  • Support real-time data exchange (EDI, integration platforms)
  • Leverage analytics to inform utilization trends, clinical outcomes, and population health initiatives

Quality, Training & Performance Management:

  • Establish quality assurance programs, audit processes, and performance standards
  • Develop and deliver training programs for clinical and operational staff
  • Implement dashboards and KPIs to measure productivity, compliance, and outcomes
  • Foster a culture of continuous improvement and accountability
Requirements:
  • Active Registered Nurse (RN) license
  • Minimum 5+ years of Utilization Review leadership experience
  • Strong knowledge of MCG guidelines, regulatory standards, and claims integration
  • Preferred experience within a TPA or health plan environment
  • Preferred familiarity with clinical platforms, workflow automation, and interoperability tools

Why Join Cobalt Benefits Group?

Cobalt Benefits Group is a trusted third-party administrator specializing in self-funded benefit plans. With over 30 years of experience and 180+ employees, we support employers through customized health plan administration, claims management, and specialized programs including FSAs, HSAs, COBRA, and retiree billing.

After a 60-day waiting period, full-time employees are eligible for a comprehensive benefits package, including:

  • Medical, dental, and vision coverage with employer HSA contributions
  • Company-paid life, AD&D, and disability insurance
  • 401(k) with up to a 6% employer match
  • Generous paid time off, sick time, and 10+ paid holidays
  • Flexible Spending Accounts
  • A collaborative culture with regular company events