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Utilization Review information

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$41

$68

How much do utilization review jobs pay per hour?

As of Jun 21, 2026, the average hourly pay for utilization review 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 jobs pay $10,000 a month without a degree?

Utilization Review roles typically do not pay $10,000 a month without relevant experience or certifications; most positions in this field pay lower salaries. High-paying jobs that can reach this level without a degree often include specialized sales, real estate, or entrepreneurship, but they usually require significant skills, networking, or business acumen. Achieving such income without a degree generally involves gaining expertise, certifications, or building a successful independent business.

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.

What is the least stressful healthcare job?

Utilization review is often considered a less stressful healthcare job because it typically involves reviewing medical cases and insurance claims in a predictable, office-based environment. It usually requires strong analytical skills and certification but involves less direct patient interaction and emergency situations compared to clinical roles.

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 obtains certification in utilization review or case management. Gaining experience in healthcare settings and understanding insurance policies and medical coding can also improve job prospects. Certification programs like the Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM) are often preferred by employers.
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 jobs in Rochester, NY? For Utilization Review jobs in Rochester, NY, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Rochester, NY look for? The top searched job categories for Utilization Review jobs in Rochester, NY are:
What cities near Rochester, NY are hiring for Utilization Review jobs? Cities near Rochester, NY with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Rochester, NY as of June 2026, with employment types broken down into 100% Full Time. Highlights an 68% In-person, and 32% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.

Registered Nurse - Utilization Review - RNSC

NavitasPartners

Rochester, NY • On-site

$60/hr

Other

Posted 11 days ago

Job description

Registered Nurse (RN) - Utilization Review

Location: Syracuse, NY

Job Type: 14-Week Contract | Traveler or Local

Shift: Day Shift (Monday-Friday)

Hours: 8 Hours Per Day

Pay Rate: $60 - $65/hour

Position Overview

We are seeking an experienced Registered Nurse (RN) with Utilization Review and acute care experience to support medical necessity reviews, regulatory compliance, and care coordination activities. The RN will collaborate with physicians, case managers, insurance providers, and interdisciplinary teams to ensure appropriate utilization of healthcare services while promoting quality and cost-effective patient care.

Requirements

  • Active New York State Registered Nurse (RN) License required.

  • Current BLS Certification required or ability to recertify.

  • Minimum 1.5 years of recent acute care hospital experience required.

  • Utilization Review, Utilization Management, or Case Management experience strongly preferred.

  • Familiarity with InterQual and/or MCG criteria required or strongly preferred.

  • Knowledge of CMS regulations related to hospital admissions and inpatient criteria required.

  • Experience working with healthcare payers and regulatory agencies preferred.

  • EPIC EMR experience preferred.

  • Strong analytical, communication, and documentation skills.

  • Clean professional license history with no suspensions, investigations, or malpractice claims.

  • Must pass all required health, drug screening, and background check requirements.

Responsibilities

  • Conduct clinical reviews for inpatient admissions and continued stay authorization.

  • Apply InterQual, MCG, and evidence-based criteria for medical necessity determinations.

  • Review patient charts and clinical documentation for appropriateness of care.

  • Collaborate with physicians, case managers, and interdisciplinary teams.

  • Communicate with insurance companies, payers, and regulatory agencies regarding authorization decisions.

  • Support discharge planning and appropriate level-of-care transitions.

  • Ensure compliance with CMS regulations and hospital policies.

  • Document utilization review decisions accurately and timely in EMR systems.

Certification & Licensure

  • New York State Registered Nurse (RN) License

  • Basic Life Support (BLS)

Preferred Qualifications

  • Experience with InterQual and/or MCG Criteria

  • Prior Utilization Management or Case Management Experience

  • EPIC EMR Experience

  • Experience Working with Insurance Payers and Regulatory Agencies

Facility Highlights

  • Acute Care Hospital Environment

  • Collaborative Case Management and Utilization Review Department

  • Focus on Regulatory Compliance and Efficient Patient Flow

  • Strong Interdisciplinary Team Structure

For More Details

Email: hdavda@navitashealth.com
Call/Text: 516-862-1169

About Navitas Healthcare, LLC

It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

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