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How much do utilization review jobs pay per hour?

As of May 28, 2026, the average hourly pay for utilization review in Rochester, NY is $41.74, 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 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 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.
More about Utilization Review jobs
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:
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Utilization Review jobs near you

RN - Case Manager / Utilization Review / CDI - RNCMJM

NavitasPartners

Canandaigua, NY

Other

Posted 6 days ago

Job description

Title: RN - Case Manager / Utilization Review / CDI

Location: Syracuse

State: New York

Duration: 14 Weeks (High possibility of extension or permanent placement)

Schedule: Day Shift | Monday - Friday
Shift Timing: 9:00 AM - 5:30 PM
Weekly Hours: 42.5 Hours

Position Overview:

"Navitas Healthcare, LLC" is seeking an experienced RN - Case Manager / Utilization Review / CDI to support clinical documentation integrity, utilization review processes, discharge planning, and care coordination within an acute care environment. The RN will collaborate with interdisciplinary healthcare teams to ensure appropriate resource utilization, accurate documentation, regulatory compliance, and continuity of patient care. Candidates with MDS (Minimum Data Set) experience are strongly preferred.

Primary Responsibilities:

  • Perform case management and utilization review activities for acute care patients

  • Review clinical documentation to ensure accuracy, completeness, and compliance

  • Coordinate patient care plans and discharge planning activities

  • Collaborate with physicians, nursing staff, and interdisciplinary healthcare teams

  • Monitor resource utilization and support medical necessity reviews

  • Maintain accurate and timely documentation within EPIC EMR

  • Participate in quality improvement and compliance initiatives

  • Ensure adherence to hospital policies, payer guidelines, and regulatory standards

  • Communicate effectively with patients, families, providers, and care teams

Required Qualifications:

  • Minimum 1.5 years of recent acute care nursing experience within the past 2 years

  • Previous experience in Case Management, Utilization Review, CDI, or related clinical coordination role preferred

  • MDS (Minimum Data Set) experience required

  • Strong analytical, communication, and organizational skills

  • Ability to work independently in a fast-paced healthcare environment

  • Travelers must have experience in hospitals of equal or greater size or trauma centers

Education Requirements:

  • Graduate from an accredited School of Nursing required

  • Bachelor of Science in Nursing (BSN) preferred

Licensure / Certification:

  • Active New York State RN License required

  • BLS Certification required

  • Case Management or CDI-related certifications preferred

Contact Information:
For more details contact at hdavda@navitashealth.com or Call / Text at 516-862-1169.

About Navitas Healthcare, LLC:
Navitas Healthcare is a 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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