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Rn Utilization Management Jobs in Delaware (NOW HIRING)

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 ...

ChristianaCare

RN Case Manager - Day Shift

Newark, DE · On-site

$41.28 - $66.05/hr

Utilization Management - Reviews patient status for appropriateness and anticipated payer coverage ... An active RN license in DE or a Compact State is required. * BSN required. * A minimum of three ...

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Rn Utilization Management information

See Delaware salary details

$39K

$89.6K

$163.1K

How much do rn utilization management jobs pay per year?

As of Jul 28, 2026, the average yearly pay for rn utilization management 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.

How does an RN Utilization Management professional typically collaborate with physicians and other healthcare team members?

RN Utilization Management professionals work closely with physicians, case managers, and insurance representatives to ensure patients receive appropriate, high-quality care while managing healthcare costs. They review patient records, communicate clinical findings, and may participate in interdisciplinary meetings to discuss care plans and discharge needs. Building strong relationships and maintaining open lines of communication with the care team is essential for timely authorizations and effective care coordination. This collaborative approach helps optimize patient outcomes and resource utilization.

How to make $150,000 as a nurse?

Registered nurses in utilization management can reach a $150,000 salary by gaining specialized certifications, such as Certified Case Manager (CCM), and accumulating several years of experience in the field. Working in high-demand healthcare settings, taking on leadership roles, or pursuing advanced education like a master's degree can also increase earning potential.

What does a utilization management RN do?

A utilization management RN reviews medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure patient care aligns with guidelines and policies, often using electronic health records and clinical criteria. Certification in case management or utilization review is common in this role.

What are the key skills and qualifications needed to thrive as an RN Utilization Management Nurse, and why are they important?

To thrive as an RN Utilization Management Nurse, you need a current RN license, strong clinical assessment skills, and experience in care coordination or case management. Familiarity with utilization review tools, electronic health records, and knowledge of insurance guidelines or InterQual/MCG criteria are typically required. Exceptional communication, critical thinking, and negotiation skills help facilitate collaboration among providers, payers, and patients. These abilities are crucial for ensuring appropriate resource use, compliance with regulations, and optimal patient outcomes.

How to get into utilization management as an RN?

To become an RN in utilization management, you typically need a valid nursing license and experience in clinical settings. Gaining knowledge of insurance policies, healthcare regulations, and utilization review processes is important, and some employers prefer or require certification such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Utilization Review Professional (CURP). Developing strong analytical, communication, and documentation skills can also improve job prospects in this field.

What is the difference between Rn Utilization Management vs Rn Case Management?

AspectRn Utilization ManagementRn Case Management
CertificationsRN license, possibly certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentUtilization review departments, insurance companies, hospitalsCommunity clinics, hospitals, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Both roles require an RN license, but Rn Utilization Management focuses on reviewing the necessity of services, while Rn Case Management emphasizes coordinating patient care. Understanding these differences helps professionals choose the right career path and employers.

How to make an extra $2000 a month as a nurse?

Rn Utilization Management professionals can increase income by taking on overtime, working per diem shifts, or pursuing additional certifications such as case management or insurance review. Some also supplement income through consulting, remote case reviews, or part-time roles in telehealth, leveraging their clinical expertise and utilization review skills.

What are RN Utilization Management nurses?

RN Utilization Management nurses are registered nurses who specialize in reviewing healthcare services to ensure patients receive appropriate and cost-effective care. They evaluate the necessity, efficiency, and quality of medical treatments and procedures, often working with insurance companies, hospitals, or healthcare organizations. Their responsibilities include reviewing patient records, coordinating with clinical staff, making coverage recommendations, and ensuring compliance with healthcare regulations. This role helps manage healthcare costs while maintaining high standards of patient care.
What are popular job titles related to Rn Utilization Management jobs in Delaware? For Rn Utilization Management jobs in Delaware, the most frequently searched job titles are:
What job categories do people searching Rn Utilization Management jobs in Delaware look for? The top searched job categories for Rn Utilization Management jobs in Delaware are:
What cities in Delaware are hiring for Rn Utilization Management jobs? Cities in Delaware with the most Rn Utilization Management job openings:
Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in Delaware as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $89,560 per year, or $43.1 per hour.
RN Utilization Management - Day Shift

RN Utilization Management - Day Shift

ChristianaCare

Newark, DE • On-site

$85K - $137K/yr

Full-time

Medical, Retirement, PTO

Posted 6 days ago

ChristianaCare rating

7.8

Company rating: 7.8 out of 10

Based on 126 frontline employees who took The Breakroom Quiz

131st of 890 rated healthcare providers

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

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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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