ZipRecruiter

Log In

1

Nurse Practitioner Utilization Review Jobs in Delaware

Anesthesia Inc

Nurse Practitioner

Newark, DE · On-site

Perform preoperative chart reviews for inpatient add‑on surgical patients. * Respond to questions ... Active NP/APRN licensure in the State of Delaware. * Current BLS and ACLS certifications.

Bayhealth

Nurse Practitioner

Dover, DE · On-site

Reviews all lab data and documents. Issues prescriptions to patients based on Federal & State ... Nurse Practitioner ; * Credential(s): Registered Nurse Nurse Practitioner Nurse Practitioner ...

Anesthesia Services

Nurse Practitioner

Newark, DE · On-site

The NP will work closely with anesthesiologists, the PEP/PAE team, surgical teams, and ... Perform preoperative chart reviews for inpatient add‑on surgical patients. * Respond to questions ...

Bayhealth

Nurse Practitioner

Dover, DE · On-site

Reviews all lab data and documents. Issues prescriptions to patients based on Federal & State ... Nurse Practitioner ; * Credential(s): Registered Nurse Nurse Practitioner Nurse Practitioner ...

Christiana Care Health Services

$85K - $137K/yr

UTILIZATION MANAGEMENT * Performs admission and concurrent review to identify medical necessity ... Reviews the admission assessment and collaborates with primary nurse and other health care ...

Christiana Care Health Services

$85K - $137K/yr

UTILIZATION MANAGEMENT * Performs admission and concurrent review to identify medical necessity ... Reviews the admission assessment and collaborates with primary nurse and other health care ...

Medi-Weightloss

Nurse Practitioner

Hockessin, DE

Position: Nurse Practitioner Company: Medi-Weightloss of Hockessin Full Time: Tuesday - Saturday ... Obtain and review patient's medical and psychosocial history information relevant to patient care.

Bayhealth

Nurse Practitioner, Medical

Dover, DE · On-site

The Nurse Practitioner works within a collaborative model to provide quality care and to improve ... cases, reviewing full work-related incident and prescribing appropriate plan of care. Documents ...

Bayhealth

Nurse Practitioner, Medical

Dover, DE · On-site

The Nurse Practitioner works within a collaborative model to provide quality care and to improve ... cases, reviewing full work-related incident and prescribing appropriate plan of care. Documents ...

next page

Showing results 1-20

All JobsNurse Practitioner Utilization Review JobsNurse Practitioner Utilization Review Jobs in Delaware

Nurse Practitioner Utilization Review information

See Delaware salary details

$71.1K

$134.5K

$210.7K

How much do nurse practitioner utilization review jobs pay per year?

As of Sep 1, 2026, the average yearly pay for nurse practitioner utilization review in Delaware is $134,485.00, according to ZipRecruiter salary data. Most workers in this role earn between $111,100.00 and $152,600.00 per year, depending on experience, location, and employer.

What is a nurse practitioner utilization review?

A Nurse Practitioner Utilization Review (NP UR) job involves evaluating medical records to ensure treatments are medically necessary, cost-effective, and compliant with healthcare guidelines. NP UR professionals work with insurance companies, healthcare organizations, or government agencies to review patient care decisions, approve or deny claims, and recommend alternative treatments when needed. They use clinical expertise to assess whether services align with best practices and healthcare policies. This role is typically non-clinical, involving case reviews, documentation, and collaboration with healthcare providers. It helps improve patient care efficiency while controlling costs.

What are common day-to-day responsibilities for a nurse practitioner utilization review?

A Nurse Practitioner Utilization Review typically spends their day evaluating patient records, determining medical necessity of treatments, and ensuring care meets established guidelines and payer requirements. This role involves frequent collaboration with physicians, case managers, and insurance representatives to clarify or appeal decisions as needed. You may also participate in team meetings, develop recommendations for optimizing utilization, and provide education to clinical staff regarding documentation or policy changes. The work is often remote or office-based, with a predictable schedule and minimal direct patient contact. This structure allows for a balanced workload and a focus on analytical aspects of patient care.

What are the key skills and qualifications needed to thrive in the nurse practitioner utilization review position, and why are they important?

To thrive as a Nurse Practitioner Utilization Review, you need advanced clinical knowledge, current NP licensure, and expertise in reviewing medical records for appropriateness of care. Familiarity with utilization management software, ICD-10/CPT coding, and case management systems is typically required, along with relevant certifications such as URAC or CCM. Strong analytical thinking, attention to detail, effective written communication, and collaboration skills help you excel in evaluating care plans and working with multi-disciplinary teams. These abilities ensure accurate assessment of healthcare services, optimal resource use, and regulatory compliance within healthcare organizations.

What are the most commonly searched types of Nurse Practitioner Utilization Review jobs in Delaware?

The most popular types of Nurse Practitioner Utilization Review jobs in Delaware are:

What are popular job titles related to Nurse Practitioner Utilization Review jobs in Delaware?

For Nurse Practitioner Utilization Review jobs in Delaware, the most frequently searched job titles are:

What job categories do people searching Nurse Practitioner Utilization Review jobs in Delaware look for?

The top searched job categories for Nurse Practitioner Utilization Review jobs in Delaware are:

Nurse Practitioner Utilization Review jobs near you
Infographic showing various Nurse Practitioner Utilization Review job openings in Delaware as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $134,485 per year, or $64.7 per hour.

Utilization Management Specialist I

Georgetown, DE • On-site

SUN Behavioral Delaware
Offices of Mental Health Practitioners • 51 - 200 employees

6.2

Company rating: 6.2 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

People enjoy working here

Learn more about SUN Behavioral Delawareexternal

Full-time

Posted 17 days ago

Job description

Position Summary:
Responsible for the coordination of case management strategies pursuant to the Case Management process. Assists and coordinates care of the patient from pre-hospitalization through discharges. Responsible for assisting with authorization of admissions to hospital. Processes retroactive reviews and appeals, copies needed documentation and writes retro/appeal letters for insurance companies to ensure coverage for patient admissions. Conducts follow up calls with insurance companies to ensure coverage for patient admissions. Participates in performance improvement activities. Attends 80% of staff meetings. Coordinates care for patient through communication with Physicians, Nurse Practitioners, Clinical Services, Nursing, Assessment and Referrals Department.
Position Responsibilities:
Clinical / Technical Skills (40% of performance review)
  • Provides thorough documentation and timely updates regarding patient status on log sheets that are prepared for daily meetings concerning admissions, reviews and discharges; including case s with limited benefits, cases in peer review/denial and /or unplanned discharges
  • Coordinates with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals. Document s and updates the denial log to reflect same.
  • Consults Business Office and/or admission staff as needed to clarify data and ensure authorization processes are complete.
  • Documents in HCS the results of admission and concurrent reviews.
  • Stays informed about changes in Medicare and Medicaid.
  • Ability to stage local laws, ordinances and practices governing involuntary hospitalization and ensure compliance with same.
  • Reviews the quality of documentation for each level of care to ensure clinical effectiveness and appropriateness of treatment.
  • Maintains an active involvement and awareness of all patient admissions, discharges and transfers to alternate levels of care. Oversees continuity of care for each level of care transition.
  • Develops and maintains processes to minimize denials and communication of same to CFO and Business Office Director.
  • Reports results of daily treatment team meetings all discharges and status of high-risk case such as limited benefits, peer reviews, denials or unplanned discharges.
  • Timely retroactive reviews and appeals within current month
  • Strong knowledge of external review organizations (i.e.: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
  • Types and mails all correspondence in a timely manner.
  • Answers the telephone in a polite manner, Communicates information to the appropriate staff.
  • Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage.
  • Support discharge planning and utilization review when necessary
  • Perform other duties as required

Safety (15% of performance review)
  • Strives to create a safe, healing environment for patients and family members
  • Follows all safety rules while on the job.
  • Reports near misses, as well as errors and accidents promptly.
  • Corrects minor safety hazards.
  • Communicates with peers and management regarding any hazards identified in the workplace.
  • Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
  • Participates in quality projects, as assigned, and supports quality initiatives.
  • Supports and maintains a culture of safety and quality.

Teamwork (15% of performance review)
  • Works well with others in a spirit of teamwork and cooperation.
  • Responds willingly to colleagues and serves as an active part of the hospital team.
  • Builds collaborative relationships with patients, families, staff, and physicians.
  • The ability to retrieve, communicate, and present data and information both verbally and in writing as required
  • Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.
  • Demonstrates adequate skills in all forms of communication.
  • Adheres to the Standards of Behavior

Integrity (15% of performance review)
  • Strives to always do the right thing for the patient, coworkers, and the hospital
  • Adheres to established standards, policies, procedures, protocols, and laws.
  • Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
  • Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
  • Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership
  • Exemplifies professionalism through good attendance and positive attitude, at all times.
  • Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
  • Ensures proper documentation in all position activities, following federal and state guidelines.

Compassion (15% of performance review)
  • Demonstrates accountability for ensuring the highest quality patient care for patients.
  • Willingness to be accepting of those in need, and to extend a helping hand
  • Desire to go above and beyond for others
  • Understanding and accepting of cultural diversity and differences

Education
  • Required: High school diploma or GED. CPR and hospital-selected de-escalation technique certification.
  • Preferred: Associates or Bachelors degree.
  • Maintains education and development appropriate for position.
  • May substitute experience for education

Experience
  • Required: One year of experience in a behavioral healthcare setting.
  • Preferred: Previous experience in a Utilization Management department or as a Mental Health Tech
  • May substitute education for experience

What Sun Behavioral Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply