Utilization Management Specialist Jobs in New York
Utilization Management Specialist jobs in New York are among the most active in the country, with strong demand from health plans, hospital systems, and managed care organizations at every level from entry-level reviewer through senior clinical lead. Most hiring is concentrated in New York City, Albany, and Buffalo, where major employers such as EmblemHealth, Northwell Health, and MetroPlus Health Plan maintain large UM departments. Behavioral health, Medicare Advantage, and complex case coordination are the most consistently in-demand specialty areas. Find a role that fits below and apply directly.
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Showing 5 of 20+ Utilization Management Specialist jobs
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
- Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs
- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Typical office working environment with productivity and quality expectations.
- Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
- Sedentary work involving periods of sitting, talking, listening.
- Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
- Effective communication skills, both verbal and written
Required Qualifications
- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
- Must have active current and unrestricted RN licensure in state of residence
- Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
- This specific position hours are from 8 AM – 5 PM ET
Preferred Qualifications
- 2+ years of clinical experience required in med surg or specialty area
- Managed Care experience preferred, especially Utilization Management
- Preference for those residing in EST zones
Education
Associates Degree required
BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 - $74.78This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/17/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours.
- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care
- Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs
- Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Typical office working environment with productivity and quality expectations.
- Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
- Sedentary work involving periods of sitting, talking, listening.
- Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
- Effective communication skills, both verbal and written
Required Qualifications
- 2+ years of experience as a Registered Nurse in adult acute care/critical care setting
- Must have active current and unrestricted RN licensure in state of residence
- Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours
- This specific position hours are from 8 AM – 5 PM ET
Preferred Qualifications
- 2+ years of clinical experience required in med surg or specialty area
- Managed Care experience preferred, especially Utilization Management
- Preference for those residing in EST zones
Education
Associates Degree required
BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$26.01 - $74.78This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 08/17/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
See All 20 Utilization Management Specialist Jobs in New York
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Find JobsUtilization Management Specialist Jobs by City in New York
Where New York roles are concentrated, by current openings.
Utilization Management Specialist Job Market in New York
A snapshot from current New York openings, updated as new roles post.
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services
- Insurance
What New York Employers Look For
The qualifications that appear most often in utilization management specialist jobs across New York.
- Active New York RN license or licensed clinical social worker credential required
- Two or more years of clinical or managed care utilization review experience preferred
- Working knowledge of InterQual or Milliman care guidelines for medical necessity determinations
- Familiarity with New York State Department of Health regulations and Medicaid managed care requirements
- Proficiency with electronic health records and utilization management platforms such as Jiva or Facets
- Strong written communication skills for producing clear, timely clinical documentation and appeal responses
Utilization Management Specialist Jobs in New York: Frequently Asked Questions
How do you become a utilization management specialist in New York?
Most utilization management specialist roles in New York require an active clinical license, typically a New York State Registered Nurse license issued by the New York State Education Department or a licensed clinical social worker credential from the same board. Employers generally expect a bachelor's degree in nursing, social work, or a related health field, plus hands-on clinical experience. Some positions accept licensed practical nurses or certified case managers as an alternative pathway into entry-level reviewer roles.
Which companies hire utilization management specialists in New York?
Employers hiring utilization management specialists in New York right now include Nascentia Health, CVS Health, and MetroPlusHealth, based on current listings on Migrate Mate as of August 2026. New York's dense concentration of health plans, hospital-owned insurance products, and Medicaid managed care organizations means consistent demand from both large systems and regional payers operating under New York State Department of Health oversight.
Which New York cities have the most utilization management specialist jobs?
New York, New York State, and Syracuse account for the largest share of utilization management specialist openings in New York. New York City leads because of its concentration of major health plans, managed care organizations, and large academic medical centers, while Albany draws openings tied to state agency contracts and regional health plans, and Buffalo anchors demand in western New York through large regional health systems and insurer regional offices.
Are there remote utilization management specialist jobs in New York?
Yes, and more than most clinical fields, since utilization review is largely documentation and phone-based work that does not require physical patient contact. About 100% of utilization management specialist openings tied to New York are remote or hybrid as of August 2026, reflecting the role's suitability for distributed teams. Prior authorization review and telephonic case management are the functions most commonly offered on a fully remote basis by New York employers.
How can I get hired as a utilization management specialist in New York with little or no experience?
The most realistic entry path is a lateral move from a direct clinical role, since New York health plans and managed care organizations such as EmblemHealth and Healthfirst regularly bring on staff with bedside nursing or hospital discharge planning backgrounds for entry-level prior authorization reviewer positions. Case management coordinator and care transitions roles at New York hospital systems also serve as a direct bridge. Earning a certified case manager credential strengthens any application and is weighted heavily by New York managed care employers.
Where can I find and apply to utilization management specialist jobs in New York?
You can find and apply to utilization management specialist jobs in New York on Migrate Mate, which lists current openings from New York employers. Search the listings, find roles that match your experience and preferred location, and apply directly to the ones that fit.
See All 20 Utilization Management Specialist Jobs in New York
Find roles in New York that match your experience and apply in just a few clicks.
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