Utilization Management Nurse Jobs in New York
Utilization management nurse jobs in New York are among the most active in the country, concentrated in health insurance and managed care, large hospital systems, and government health programs, with openings at every level from entry-level case reviewers through senior clinical advisors. New York City, Albany, and Buffalo are the primary hiring hubs, anchored by well-known employers such as EmblemHealth, Northwell Health, and MetroPlus Health. Medical necessity review, care coordination, and behavioral health utilization are the most in-demand specialties across the state. Find a role that fits below and apply directly.
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Showing 5 of 6+ Utilization Management Nurse jobs
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):
601 Elmwood Ave, Rochester, New York, United States of America, 14642
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
500009 Utilization Management
Work Shift:
UR - Day (United States of America)
Range:
UR URCD 215
Compensation Range:
$80,923.00 - $105,208.00
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:
Works collaboratively with various departments across the entire health care system to review clinical documentation, utilizing evidence based criteria to support medical necessity and appropriate level of patient care for services provided. Reports outcome trends and patterns to UM leadership to help identify educational opportunities and performance improvement initiatives across the health care continuum. Adapts to process changes and assists with education efforts that support ongoing improvement.
ESSENTIAL FUNCTIONS
- Determines level of care per regulatory requirements. Provides level of care notifications to patients and families as needed.
- Works collaboratively with payers to ensure authorization for dates of service. Collaborates with HIM, providers, Financial Counseling and Patient Financial Services. Monitors all UM hold bills and unplanned readmission reports.
- Conducts initial and concurrent reviews, utilizing evidence based criteria through Interqual. Supports discharge appeal process. Responsible for departmental denials and appeal activity.
- Documents according to regulatory guidelines and UM RN workflow protocols. Conducts clinical documentation improvement efforts through query process.
- Meets productivity expectations established by UM department.
- Provides and supports ongoing educational needs for all UM customers.
- Other duties as assigned.
MINIMUM EDUCATION & EXPERIENCE
Associate's degree in Nursing and 3 years of acute hospital experience required
Bachelor's degree in Nursing (BSN) preferred
Or equivalent combination of education and experience
Utilization Management experience preferred
KNOWLEDGE, SKILLS AND ABILITIES
Database experience including: Interqual, Sharepoint, eRecord, ePARC, Cobius preferred
LICENSES AND CERTIFICATIONS
RN - Registered Nurse - State Licensure and/or Compact State Licensure NYS Registered Nurse license upon hire required
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.
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):
601 Elmwood Ave, Rochester, New York, United States of America, 14642
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
500009 Utilization Management
Work Shift:
UR - Day (United States of America)
Range:
UR URCD 215
Compensation Range:
$80,923.00 - $105,208.00
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:
Works collaboratively with various departments across the entire health care system to review clinical documentation, utilizing evidence based criteria to support medical necessity and appropriate level of patient care for services provided. Reports outcome trends and patterns to UM leadership to help identify educational opportunities and performance improvement initiatives across the health care continuum. Adapts to process changes and assists with education efforts that support ongoing improvement.
ESSENTIAL FUNCTIONS
- Determines level of care per regulatory requirements. Provides level of care notifications to patients and families as needed.
- Works collaboratively with payers to ensure authorization for dates of service. Collaborates with HIM, providers, Financial Counseling and Patient Financial Services. Monitors all UM hold bills and unplanned readmission reports.
- Conducts initial and concurrent reviews, utilizing evidence based criteria through Interqual. Supports discharge appeal process. Responsible for departmental denials and appeal activity.
- Documents according to regulatory guidelines and UM RN workflow protocols. Conducts clinical documentation improvement efforts through query process.
- Meets productivity expectations established by UM department.
- Provides and supports ongoing educational needs for all UM customers.
- Other duties as assigned.
MINIMUM EDUCATION & EXPERIENCE
Associate's degree in Nursing and 3 years of acute hospital experience required
Bachelor's degree in Nursing (BSN) preferred
Or equivalent combination of education and experience
Utilization Management experience preferred
KNOWLEDGE, SKILLS AND ABILITIES
Database experience including: Interqual, Sharepoint, eRecord, ePARC, Cobius preferred
LICENSES AND CERTIFICATIONS
RN - Registered Nurse - State Licensure and/or Compact State Licensure NYS Registered Nurse license upon hire required
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.
See All 6 Utilization Management Nurse Jobs in New York
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Find JobsUtilization Management Nurse Jobs by City in New York
Where New York roles are concentrated, by current openings.
Utilization Management Nurse Job Market in New York
A snapshot from current New York openings, updated as new roles post.
Who's Hiring
- Oscar Health2
- Albany Medical Center1
- Healthfirst1
- Oscar Management Corporation1
Top Industries Hiring
- Insurance2
- Education1
- Healthcare & Medical Services1
What New York Employers Look For
The qualifications that appear most often in utilization management nurse jobs across New York.
- Active New York State Registered Nurse license in good standing required
- Minimum two to three years of clinical nursing experience in an acute care or managed care setting
- Working knowledge of InterQual or Milliman clinical criteria for medical necessity review
- Certified Case Manager credential or Accredited Case Manager designation strongly preferred
- Experience conducting prior authorization, concurrent review, or discharge planning determinations
- Proficiency with electronic health records and utilization management documentation platforms
Utilization Management Nurse Jobs in New York: Frequently Asked Questions
How do you become a utilization management nurse in New York?
Start by holding an active New York State Registered Nurse license, which is issued by the New York State Education Department's Office of the Professions after passing the NCLEX-RN. Most employers require at least two years of clinical bedside experience in an acute, specialty, or managed care setting before hiring into a utilization management role. Adding a Certified Case Manager credential strengthens your application significantly and is often listed as preferred in New York job postings.
Which companies hire utilization management nurses in New York?
Employers hiring utilization management nurses in New York right now include Albany Medical Center, Healthfirst, and Oscar Health, based on current listings on Migrate Mate as of June 2026. New York's large managed care and insurance market means health plans, Medicaid managed care organizations, and integrated health systems are consistently among the most active sources of these openings.
Which New York cities have the most utilization management nurse jobs?
New York, Albany, and Rochester have the most utilization management nurse openings in New York. New York City dominates due to its concentration of national health insurers, large Medicaid managed care plans, and major academic medical centers, while Albany's volume is driven by state government health programs and regional insurance carriers, and Buffalo's openings come from systems like Kaleida Health and local managed care organizations.
Are there remote utilization management nurse jobs in New York?
Yes, and more than most nursing roles, since utilization management work is largely desk-based and involves reviewing records and conducting phone-based clinical consultations rather than hands-on patient care. About 50% of utilization management nurse openings tied to New York are remote or hybrid as of June 2026, reflecting how well-suited the role is to distributed work. Prior authorization and retrospective review functions are the most commonly posted as fully remote.
How can I get hired as a utilization management nurse in New York with little or no experience?
The most realistic entry path is transitioning from a clinical bedside role into case management or care coordination first, since New York employers rarely hire into utilization management without some acute or specialty nursing background. Large systems like Northwell Health and NYC Health and Hospitals run new-grad residency programs that build the clinical foundation you will need. Earning your New York RN license and completing even one year in a med-surg, telemetry, or managed care environment positions you for an entry-level utilization review associate role.
Where can I find and apply to utilization management nurse jobs in New York?
You can find and apply to utilization management nurse jobs in New York on Migrate Mate, which lists current openings from employers hiring in the state right now. Search for roles that match your experience and credentials, then apply directly to the ones that fit.
See All 6 Utilization Management Nurse Jobs in New York
Find roles in New York that match your experience and apply in just a few clicks.
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