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Utilization Reviewer Jobs in Rochester, NY (NOW HIRING)

w3r Consulting

Clinical Pharmacist

Rochester, NY · On-site

$116K - $139K/yr

Drug Utilization Review: * As a member of the DUR team , conducts evaluations, and prepares reports and recommendations on plan, member, provider and employer prescribing profiles * Participates in ...

w3r Consulting

Clinical Pharmacist

Rochester, NY · On-site

$55/hr

Drug Utilization Review: * As a member of the DUR team, conducts evaluations, and prepares reports and recommendations on plan, member, provider and employer prescribing profiles * Participates in ...

Acacia Network

Program Director

Rochester, NY · On-site

$85K/yr

Perform utilization reviews, monitoring case records, ensuring compliance with all contract stipulations. * Review OASAS Website keeping updated with 820 regulations and local service bulletins.

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

$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

$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

$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

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

Rochester, NY

$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

$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

Rochester, NY

$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 ...

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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

$32.1K

$39.3K

$45.5K

How much do utilization reviewer jobs pay per year?

As of Aug 12, 2026, the average yearly pay for utilization reviewer in Rochester, NY is $39,324.00, according to ZipRecruiter salary data. Most workers in this role earn between $35,200.00 and $43,500.00 per year, depending on experience, location, and employer.

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 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 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.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Rochester, NY? 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 89% Full Time, 8% Part Time, and 3% Contract. Highlights an 97% In-person, and 3% Remote job distribution, with an average salary of $39,324 per year, or $18.9 per hour.

UR Cardiac Care Flex Team - Registered Nurse 2, Inpatient

University of Rochester

Rochester, NY • On-site

$40.03 - $54.04/hr

Full-time

Re-posted 17 days ago

University Of Rochester rating

8.3

Company rating: 8.3 out of 10

Based on 186 frontline employees who took The Breakroom Quiz

126th of 618 rated colleges and universities

Job description

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
Job Location (Full Address):
220 Hutchison Rd, Rochester, New York, United States of America, 14620
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
500424 Heart Flex Team/Nrsg-SMH
Work Shift:
Range:
UR URCG 215 H
Compensation Range:
$40.03 - $54.04
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Responsibilities:
The Level II Registered Nurse, under the direction of the Nurse Manager, is accountable for provision of competent direct patient care based on established standards. The Level II Registered Nurse contributes to unit activities and supports enhancement of the care delivery system at the unit level. The Level II Registered Nurse supports peers in the delivery of patient care services and assumes an expanded role which may include charge nurse, preceptor, and committee member responsibilities.
Schedule
FT, PT and Per Diem positions available. D/E/N weekends and holidays as required. Straight Night and Evening shifts available.
Responsibilities
Unique offering to explore the rewarding nursing care of cardiac patients throughout our Cardiac Care service line with opportunity for professional growth as well as advanced clinical skill building. Patient populations include the continuum of pre-procedural to post-surgical care of patients with varied cardiovascular and thoracic disease states including advanced heart failure and mechanical circulatory support. Flex team members generally complete an eight week assignment on one of our units. Successful candidates will demonstrate flexibility, critical thinking, excellent communication and organizational skills and willingness to work in variable settings and teams. Orientation to the units and new populations are provided. One year of adult med surg or cardiac experience required. ICU experience is a plus. Opportunities for clinical advancement are supported and encouraged. Ask about the potential options for special scheduling arrangements.
Qualifications
Requires a Diploma, Associate or Bachelor's degree from an accredited Nursing Program and an active New York State RN license in good standing. Applicants will have a minimum of 6-12 months of RN experience. This position assumes the charge nurse role, actively participates in unit/service activities, supports co-workers, and assesses unit needs.
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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