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Utilization Reviewer Jobs in Rochester, NY (NOW HIRING)

DePaul

Operations Manager

Rochester, NY

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other meetings. * Observe all safety rules and regulations for self and others. * Collaborate with the ...

DePaul

Operations Manager

Rochester, NY

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other meetings. * Observe all safety rules and regulations for self and others. * Collaborate with the ...

DePaul

Operations Manager

Rochester, NY · On-site

$25 - $26.20/hr

Give relevant input for treatment team meetings, staff meetings, utilization reviews and any other meetings. * Observe all safety rules and regulations for self and others. * Collaborate with the ...

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

$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 ...

Paragon 28, Inc.

Regional Sales Coordinator

Rochester, NY · On-site

$57K - $75K/yr

Handles Agency hardware allocations and monitors late loaners to drive asset utilization * Assists with the distribution of allocations, and pullbacks for the quarterly consignment review process

Lthc

Manager, Data Platforms Admin

Rochester, NY · On-site +1

Uses project management tools for effective personnel utilization, to track and report progress, and to ensure compliance with project implementation schedules. Reviews and approves the major ...

New

L3HHCM20

Lead, Government Compliance

Rochester, NY

$87K - $196K/yr

Complete government Purchase Order compliance reviews to support maintaining an approved purchasing ... Evaluate Request for Proposal (RFP) requirements for Small Business utilization and participation.

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Showing results 1-20

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 Jul 23, 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 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.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in healthcare or insurance, strong analytical skills, and knowledge of medical coding and documentation are important; some employers may also require certification such as the Certified Professional Medical Auditor (CPMA).

Is utilization review a stressful job?

Utilization reviewers often work in a fast-paced environment where accuracy and attention to detail are essential, which can contribute to job stress. The role may involve managing high caseloads and strict deadlines, but stress levels vary depending on the work setting and individual coping strategies.

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, and why are they important?

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.

Is utilization review work from home?

Utilization reviewer jobs can often be performed remotely, especially in organizations that utilize electronic health records and telecommunication tools. Many employers offer work-from-home options for this role, which typically requires strong analytical skills, knowledge of healthcare policies, and certification in case management or utilization review. However, some positions may require on-site presence depending on company policies and regulatory requirements.

What jobs pay 4000 a week without a degree?

Utilization reviewers typically do not earn $4,000 a week without a degree; this role usually requires healthcare or insurance industry experience and certifications. High-paying jobs that can reach this level without a degree often include sales, real estate, or skilled trades like plumbing or electrical work, which rely on experience and skills rather than formal education.
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 July 2026, with employment types broken down into 78% Full Time, 11% Part Time, and 11% Contract. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $37,486 per year, or $18 per hour.
Patient Financial Services Representative

Patient Financial Services Representative

King's Daughters

Pavilion, NY • On-site

$16.25 - $17.75/hr

Full-time

Posted 22 days ago

King's Daughters Health System rating

6.3

Company rating: 6.3 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

672nd of 889 rated healthcare providers

Job description

At UK King's Daughters, we're not just a healthcare facility - we're a family of dedicated professionals who share a passion for making a meaningful difference in the lives of our patients. We're more than just a place to work; we're a place to grow, thrive, and contribute to our community.

Job Description:

Job Summary

Responsible for managing moderate-complexity patient account activities to optimize reimbursement and reduce accounts receivable. Provides expertise in billing, follow-up, collections, and/or denials resolution to improve financial outcomes. Ensures accuracy of charge, claim, and payment data through reviews and targeted corrections. Recommends workflow improvements, reporting insights, and queue management practices that elevate productivity. Coordinates cross-functional problem solving with coding, clinical, and payer partners to support organizational financial objectives.


Essential Functions

Provides expertise in billing, follow-up, collections, and/or denials resolution. Performs timely follow-up on outstanding claims and appeals to meet aging and recovery targets.

Reviews charge, payment, and adjustment activity to identify variances and initiate corrective action.

Reconciles patient balances and payer remittances to ensure accurate application of payments and adjustments.

Communicates professionally with stakeholders regarding estimates, statements, and complex balance questions.

Collaborates with coding, authorization, and utilization review teams to resolve documentation and coverage gaps.

Maintains compliance with HIPAA, FDCPA, and payer contract provisions in all actions.

Performs other duties as assigned.


Education Requirement: High school diploma or equivalent


Experience Requirement: 2-3 years of experience

An equivalent combination of education and experience may be considered. All experience must be paid and in the same related field. Part-time and PRN experience will be prorated based on hours worked per week. Volunteer work and internships for academic credit are not counted.


Certifications & Licensures: N/A


Working Conditions

A. Lifting, pushing, and/or pulling objects up to 50lbs:2. Occasional (< 10% of the time)

B. Lifting, pushing, and/or pulling objects over 50lbs:1. Never

C. Standing or walking with objects up to 10lbs:3. Intermittent (10% - 50% of the time)

D. Standing or walking with objects up to 25lbs:2. Occasional (< 10% of the time)

E. Sitting at the computer workstation for extended periods:3. Intermittent (10% - 50% of the time)

F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials:2. Occasional (< 10% of the time)

G. Repetitive motion:3. Intermittent (10% - 50% of the time)

H. Working at heights above 4 feet:1. Never

I. Working in confined spaces:1. Never

J. Risk of injuries from use of equipment on the job:2. Occasional (< 10% of the time)

K. Job-related travel:2. Occasional (< 10% of the time)

L. Loud noises:1. Never

M. Temperature extremes:1. Never

N. Hazardous chemicals and fumes including waste:2. Occasional (< 10% of the time)

O. Radiation:1. Never

P. Burns:1. Never

Q. Cuts/Punctures:2. Occasional (< 10% of the time)

R. Bloodborne/airborne pathogens:2. Occasional (< 10% of the time)

S. Recombinant DNA or viral vectors:1. Never

T. Combative/violent people:1. Never

U. Animal handling (including carcasses):1. Never

V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A


Physical Demands

This position requires intermittent sitting at a computer workstation for extended periods of time; performing tasks with repetitive motions (such as typing); intermittent standing or walking with objects weighing up to 10 pounds; occasional standing or walking with objects weighing up to 25 pounds; and occasional lifting, pushing, or pulling objects weighing up to 50 pounds.

Department:

Patient Financial Experience

Shift:

Days (United States of America)

Time Type:

Full time

Address:

2000 Ashland Drive

City, State:

Ashland, Kentucky

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