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Utilization Review Jobs in Rochester, NY (NOW HIRING)

Lthc

Medical Director, Commercial

Rochester, NY

Utilization review activities include: reviews of requests for broad range of medical services including medications, medical and surgical services at first level, appeal and inquiries. * Conducts ...

Lthc

Medical Director, Commercial

Rochester, NY · On-site

Utilization review activities include: reviews of requests for broad range of medical services including medications, medical and surgical services at first level, appeal and inquiries. * Conducts ...

Lthc

Medical Director, Commercial

Rochester, NY · On-site

Utilization review activities include: reviews of requests for broad range of medical services including medications, medical and surgical services at first level, appeal and inquiries. * Conducts ...

Mvphealthcare

Concurrent Review - RN

Rochester, NY · Remote

$69K - $92K/yr

Ideal for experienced RNs looking to expand into utilization management, this position provides ... Reviews inpatient medical records against established criteria and standards to determine medical ...

Lthc

Utilization Management Services Rep I

Rochester, NY · On-site

$15.75 - $21.50/hr

Summary: This position supports the Utilization Management (UM) workflows by providing ... review and creation of desk level procedures, acting as a subject matter expert for UM Services.

Lthc

Utilization Management Services Rep I

Rochester, NY · On-site

$15.75 - $21.50/hr

Summary: This position supports the Utilization Management (UM) workflows by providing ... review and creation of desk level procedures, acting as a subject matter expert for UM Services.

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · Remote

$65K - $120K/yr

Engage in the Utilization Review process for assigned cases every month * Respond to clinical crises and other clinical issues brought forward by supervisees * Help develop and improve clinical ...

Athena

LCSW Clinical Supervisor - Remote

Rochester, NY · On-site

$65K - $120K/yr

Engage in the Utilization Review process for assigned cases every month * Respond to clinical crises and other clinical issues brought forward by supervisees * Help develop and improve clinical ...

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Utilization Review information

See Rochester, NY salary details

$21

$41

$68

How much do utilization review jobs pay per hour?

As of Jul 13, 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 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 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 July 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $86,774 per year, or $41.7 per hour.
Director, Care Management & Social Work - UH, UMMC, NWCH, CSHC

Director, Care Management & Social Work - UH, UMMC, NWCH, CSHC

Rochester Regional Health

Irondequoit, NY • On-site

$85K - $135K/yr

Full-time

Posted 10 days ago

Rochester Regional Health rating

7.4

Company rating: 7.4 out of 10

Based on 216 frontline employees who took The Breakroom Quiz

265th of 882 rated healthcare providers

Job description

Director, Care Management & Social WorkUnity Hospital, United Memorial Medical Center, Newark Wayne Community Hospital and Clifton Springs Hospital and Clinic

SUMMARY:

The Director is primarily responsible for managing utilization review and discharge planning activities, as well as addressing psychosocial needs to appropriately transition patients through the continuum of care. Working collaboratively with the MD Advisor for Care Management, the Director also is responsible for building coalitions with all members of the care team as well as hospital and health system leadership to implement changes to improve patient flow, the patient experience, and staff and physician satisfaction, as well as increase reimbursement and reduce denials.

RESPONSIBILITIES:

  • Lead the development, implementation, and evaluation of strategic department plans to optimize length of stay, discharge planning, patient flow, and resource utilization across the hospital.

  • Oversee utilization and denial management programs, ensuring appropriate levels of care, strong payer relationships, adherence to regulations, and proactive strategies to reduce denials and prevent readmissions.

  • Build and maintain effective internal and external partnerships to drive process improvement, monitor performance metrics, and support optimal clinical, operational, financial, and patient satisfaction outcomes.

  • Manage departmental operations including staffing, budgeting, role development, performance evaluations, regulatory compliance, and quality review processes.

  • Serve as a consultant and liaison for long-term care facilities and state agencies, ensuring regulatory alignment, supporting complex psychosocial needs, and guiding policy, risk management, and patient experience initiatives.

  • Perform other related duties as assigned.

REQUIRED QUALIFICATIONS:

  • BSN or Master's Degree in Social Work

  • RN or LMSW license

  • Minimum of five years in Health Care setting, three years in supervisory capacity

PREFERRED QUALIFICATIONS:

  • Case management/utilization review/discharge planning experience

EDUCATION:

MS: Social Work (Required)

LICENSES / CERTIFICATIONS:

BLS - Basic Life Support - American Heart Association (AHA)American Heart Association (AHA)American Heart Association (AHA), LCSW - Licensed Clinical Social Worker - New York State Education Department (NYSED)New York State Education Department (NYSED)New York State Education Department (NYSED)

PHYSICAL REQUIREMENTS:

S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE:

$85,000.00 - $135,000.00

CITY:

Rochester

POSTAL CODE:

14617

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.

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