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Utilization Reviewer Jobs in Rochester, NY (NOW HIRING)

DePaul

Residential Assistant

Batavia, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

DePaul

Residential Assistant

Batavia, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Education : High School ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

DePaul

Residential Assistant

Batavia, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

DePaul

Residential Assistant

Batavia, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Education : High School ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Education : High School ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Education : High School ...

DePaul

Residential Assistant

Rochester, NY · On-site

$21 - $21.30/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews, and any other meetings. 2. Observe all safety rules and regulations for self and others. Qualifications Education

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Showing results 21-40

All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Rochester, NY

Utilization Reviewer information

See Rochester, NY salary details

$30.6K

$37.5K

$43.4K

How much do utilization reviewer jobs pay per year?

As of Sep 5, 2026, the average yearly pay for utilization reviewer in Rochester, NY is $37,486.00, according to ZipRecruiter salary data. Most workers in this role earn between $33,500.00 and $41,400.00 per year, depending on experience, location, and employer.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
More about Utilization Reviewer jobs

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

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

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

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

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

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Rochester, NY as of August 2026, with employment types broken down into 92% Full Time, and 8% Part Time. Highlights an 100% In-person job distribution, with an average salary of $37,486 per year, or $18 per hour.

Medical Director of Ophthalmology - Richard E. Hoover Low Vision Center

Gbmc

Pavilion, NY • On-site

$1.0K - $675K/wk

Full-time

Posted 21 days ago

Job description

Under limited supervisions, Physician agrees to render medical services to patients of the Center in the manner and to the extent permitted by law and applicable rules of professional ethics.

Education

Medical Doctor degree or Doctor of Optometry

Experience

Minimum three years of practice Ophthalmology or Optometry, Fellowship Training/Optometry Residency Training or Prior practice of Low Vision preferred

Licensures, Certifications

Board Certified, American Board of Ophthalmology or Diplomate, American Board of Optometry; Maryland Board of Physicians Medical License or Maryland Board of Optometry License

Principal Duties and Responsibilities

  • Ophthalmic examination and assessment of the low vision patient; provide low vision rehabilitation care.

  • Coordinate, evaluate, and supervise services of the low vision occupational therapist(s) and orientation and mobility instructor

  • Provide reports of the low vision evaluations to referring doctors

  • Provide didactic instruction in and observation of low vision treatment to ophthalmology residents and other residents and students who rotate through Hoover Low Vision Services

  • Abide by all reasonable policies, procedures, rules, regulations of insurers, managed care plans, health maintenance organizations, and other third-party payers involved with the Center

  • Participate in the development and implementation of effective quality assurance and utilization review programs, including quality assurance and utilization review to the extent reasonably required by third-party payers

  • Maintain relationship with the Maryland Department of Rehabilitation Services (DORS)

  • Refer patients for services and devices to DORS, Blind Industries and Services of Maryland, and to government and community resources

  • Conduct periodic support group and informational meetings for patients

  • As the Director of the Hoover Services, in conjunction with the Chairman, Department of Ophthalmology and the practice manager/administrator, develop yearly budgets, growth strategy, and continuous improvement in practice operations. The Director will be committed to continuous development to advance excellence, innovation, and the future of low vision evaluation and rehabilitation.

All roles must demonstrate GBMC Values:

Respect

I will treat everyone with courtesy. I will foster a healing environment.

  • Treats others with fairness, kindness, and respect for personal dignity and privacy
  • Listens and responds appropriately to others' needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

  • Meets and/or exceeds customer expectations
  • Actively pursues learning and self-development
  • Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look and speak. I will take ownership to solve problems.

  • Sets a positive, professional example for others
  • Takes ownership of problems and does what is needed to solve them
  • Appropriately plans and utilizes required resources for various job duties
  • Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

  • Works cooperatively and collaboratively with others for the success of the team
  • Addresses and resolves conflict in a positive way
  • Seeks out the ideas of others to reach the best solutions
  • Acknowledges and celebrates the contribution of others

Ethical Behavior

I will always act with honesty and integrity. I will protect the patient.

  • Demonstrates honesty, integrity and good judgment
  • Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results

I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.

  • Embraces change and improvement in the work environment
  • Continuously seeks to improve the quality of products/services
  • Displays flexibility in dealing with new situations or obstacles
  • Achieves results on time by focusing on priorities and manages time efficiently

Pay Range

$1,000.00 - $675,000.00

Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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