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Apprentice Utilization Management Nurse Jobs in Delaware

Christiana Care Health Services

$85K - $137K/yr

Job Details Registered Nurse (RN) - Utilization ManagementFT Day Shift (Hrs.: 8a-4:30p) - On-site Newark, DE ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with ...

Christiana Care Health Services

$85K - $137K/yr

Job Details Registered Nurse (RN) - Utilization ManagementFT Day Shift (Hrs.: 8a-4:30p) - On-site Newark, DE ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with ...

Resolution Think

Licensed Practical Nurse (LPN)

Dover, DE · On-site

$24.75 - $33.75/hr

Review referrals requiring nursing judgment and maintain accurate referral statuses and ... Referral management, utilization management, case management, or ambulatory care preferred.

Resolution Think

Licensed Practical Nurse (LPN)

Dover, DE · On-site

$24.75 - $33.75/hr

Review referrals requiring nursing judgment and maintain accurate referral statuses and ... Referral management, utilization management, case management, or ambulatory care preferred.

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Apprentice Utilization Management Nurse information

See Delaware salary details

$39K

$89.6K

$163.1K

How much do apprentice utilization management nurse jobs pay per year?

As of Aug 30, 2026, the average yearly pay for apprentice utilization management nurse in Delaware is $89,560.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,600.00 and $104,600.00 per year, depending on experience, location, and employer.

What is an apprentice utilization management nurse?

An Apprentice Utilization Management Nurse is a nursing professional in training who assists with the review and evaluation of healthcare services to ensure they are medically necessary and cost-effective. They work under the supervision of experienced utilization management nurses and follow established guidelines to assess patient care plans, medical records, and insurance policies. Their role is crucial in helping healthcare organizations maintain quality care while managing costs, and they may interact with physicians, patients, and insurance companies to clarify or justify treatment decisions. As apprentices, they are gaining hands-on experience to develop their skills and knowledge in utilization management.

What are the key skills and qualifications needed to thrive as an apprentice utilization management nurse, and why are they important?

To thrive as an Apprentice Utilization Management Nurse, you need a foundational understanding of nursing principles, strong analytical skills, and typically an RN license or progression toward one. Familiarity with utilization management software, electronic health records (EHR), and knowledge of insurance guidelines such as Medicare or Medicaid are often required. Attention to detail, critical thinking, and effective communication are essential soft skills for collaborating with healthcare teams and conveying clinical information. These competencies ensure accurate patient care reviews, compliance with regulations, and effective support in healthcare cost management.

What are some common challenges faced by apprentice utilization management nurses, and how can they be addressed?

Apprentice Utilization Management Nurses often encounter challenges such as learning to interpret complex medical records, understanding insurance policies, and adhering to strict regulatory guidelines. Balancing patient advocacy with cost-effective care decisions can also be demanding. These challenges can be addressed by actively participating in mentorship programs, seeking regular feedback from experienced colleagues, and utilizing ongoing training resources provided by employers. Developing strong communication and organizational skills will also help manage the workload and foster effective collaboration with physicians, case managers, and insurance representatives.

What is the difference between Apprentice Utilization Management Nurse vs Utilization Management Nurse?

AspectApprentice Utilization Management NurseUtilization Management Nurse
CredentialsLicensed RN, in training or early certification stageLicensed RN with certification in utilization review
Work EnvironmentSupervised training setting, often in healthcare or insurance companiesIndependent review in healthcare or insurance organizations
Job ResponsibilitiesAssisting with case reviews, learning utilization review processesConducting case assessments, making coverage decisions

The Apprentice Utilization Management Nurse is in training, focusing on learning review procedures under supervision, while the Utilization Management Nurse is fully qualified, responsible for independent case evaluations and decision-making. The apprentice role is a stepping stone toward becoming a licensed Utilization Management Nurse.

What cities in Delaware are hiring for Apprentice Utilization Management Nurse jobs?

Cities in Delaware with the most Apprentice Utilization Management Nurse job openings:

Apprentice Utilization Management Nurse jobs near you

RN Utilization Management - Day Shift

Newark, DE • On-site

Christiana Care
Outpatient Health Care • 10K+ employees

7.8

Company rating: 7.8 out of 10

Based on 131 frontline employees who took The Breakroom Quiz

131st of 895 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Christiana Careexternal

$85K - $137K/yr

Other

Medical, Retirement, PTO

Re-posted 5 days ago

Job description

Job Details
Registered Nurse (RN) - Utilization Management
FT Day Shift (Hrs.: 8a-4:30p) - On-site
Newark, DE
ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with experience with insurance providers such as Aetna and Cigna, along with a background in an acute care hospital. RN will work on-site at the Newark Hospital.
PRIMARY FUNCTION:
Responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan.
UTILIZATION MANAGEMENT
  • Performs admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission.
  • Reviews the admission assessment and collaborates with primary nurse and other health care providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes.
  • Manages observation level of care and works with the attending physician and/or clinical provider caring for the patient to ensure observation status does not exceed 48 hours.
  • Identifies system issues that serve as barriers to care. Participates in the development and implementation of strategies to remove barriers and facilitate performance improvement measures.
  • Monitors efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate the achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
  • Reports information generated from the utilization management referral process for LOS data and physician profile database.
  • Collaborates with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
  • Notifies physician when a patient does not meet criteria for acute care hospitalization and pursues documentation to justify continued stay within 24 hours.
  • Collaborates with the Physician Advisor to facilitate the achievement of clinical, quality, financial, and patient satisfaction goals.
  • Presents "Letters of Non-Coverage" (LON) to patients and/or families when the acute stay is no longer necessary (Third Party and/or Medicare).
  • Communicates and secures continued stay authorization with Managed Care Organizations.
  • Tracks all carve-outs and submits reason codes for data entry.
  • Serves as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.
  • Trends potential barriers to patient advancement through the system intervene assertively and appropriately when necessary.
  • Provides On-call support for the Transfer Center to evaluate medical necessity and appropriateness when a request is obtained from an outside facility for patient transfer to ChristianaCare
  • Identifies the need for the patient to be evaluated by other members of the health care team and takes appropriate action to facilitate.
  • ED UM works closely with ED providers to review medical necessity and/or collaborate with ED CM for discharge planning, as appropriate.
  • Actively participates in department operational planning work groups.
Education & Experience Requirements:
  • DE RN licensure or compact state RN licensure.
  • Bachelor's degree in nursing Required.
  • Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting. critical care experience is required.
  • Minimum 3 years of Utilization Management experience required.
  • Denial management experience is required
  • Prior experience working with insurance providers is preferred.
  • Completes a minimum of 8 continuing education credits (CEU'S) per year in Utilization and/or Case Management.

PHYSICAL DEMANDS:
Ability to ambulate within the hospital setting (walking, stairs, etc.). Occasional sitting, standing, and lifting loads of 5-10 pounds. Ability to utilize computer equipment/programs. Ability to sit or stand at a computer workstation and proficiently utilize computer equipment/programs for long periods of time.
WORKING CONDITIONS:
Occasional exposure to Office materials (i.e., White Out, Toner, etc.)
Annual Compensation Range $85,862.40 - $137,384.00
This pay rate/range represents ChristianaCare's good faith and reasonable estimate of compensation at the time of posting. The actual salary within this range offered to a successful candidate will depend on individual factors including without limitation skills, relevant experience, and qualifications as they relate to specific job requirements.
Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.
Post End Date
Aug 31, 2026
EEO Posting Statement
ChristianaCare offers a competitive suite of employee benefits to maximize the wellness of you and your family, including health insurance, paid time off, retirement, an employee assistance program. To learn more about our benefits for eligible positions visit https://careers.christianacare.org/benefits-compensation/
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About ChristianaCare

Sourced by ZipRecruiter

ChristianaCare is one of the country's most dynamic health care organizations, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. ChristianaCare includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (1,299 beds), a free-standing emergency department, a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women's health. It also includes the pioneering Gene Editing Institute and was rated by IDG Computerworld as one of the nation's Best Places to Work in IT. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. It is continually ranked by U.S. News & World Report as a Best Hospital. With the unique CareVio data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care.

Industry

Outpatient health care

Company size

10,000+ Employees

Headquarters location

Wilmington, DE, US

Year founded

1888

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