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Utilization Care Manager Jobs in Delaware (NOW HIRING)

Autism Delaware

Behavioral Services Manager

Newark, DE · On-site

Support quality documentation, timely reporting, and software utilization across service areas ... Collaborate with other agencies and stakeholders to improve systems of care * Support fundraising ...

Encompass Health

Certified Case Manager

Middletown, DE · On-site

... of care communication, patient and family education, payor relations and total fiscal management. The CCM performs ongoing utilization review and acts as a liaison to the payor while assuring that ...

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Utilization Care Manager information

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

What are popular job titles related to Utilization Care Manager jobs in Delaware?

For Utilization Care Manager jobs in Delaware, the most frequently searched job titles are:

What job categories do people searching Utilization Care Manager jobs in Delaware look for?

The top searched job categories for Utilization Care Manager jobs in Delaware are:

What cities in Delaware are hiring for Utilization Care Manager jobs?

Cities in Delaware with the most Utilization Care Manager job openings:

Utilization Care Manager jobs near you
Infographic showing various Utilization Care Manager job openings in Delaware as of August 2026, with employment types broken down into 2% As Needed, 72% Full Time, 20% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

RN Case Manager - Day Shift - Sign-on Bonus

Christiana Care

Newark, DE • On-site

$41.28 - $66.05/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

ChristianaCare rating

7.8

Company rating: 7.8 out of 10

Based on 131 frontline employees who took The Breakroom Quiz

135th of 898 rated healthcare providers

Job description

Job Details
RN Case Manager - Day Shift
M-F (Hours: 8a-4:30p with call rotation every 7 weeks) No Holidays or Weekends!
Newark, DE
External Candidates are Eligible for a 10K Sign-on Bonus!
Christiana Care Hospital in Newark, DE is looking for a (RN) Case Manager with experience in Discharge Planning in an Acute Care Hospital Setting.
The RN Case Manager will coordinate care and drive patient progression to establish a discharge plan. This includes functioning as an interdisciplinary team member, creating, implementing, and developing all aspects of discharge planning to establish appropriate, timely, and effective transitions throughout the care continuum.
The Care Management Model:
Our Care Management Triad Team Model is a collaboration between the following:
  • RN Case Manager - Manages patient care, drives patient progression, and establishes a discharge plan.
  • Social Worker - Resolves psycho-social barriers and supports discharge needs.
  • Utilization Management - Reviews patient status for appropriateness and anticipated payer coverage.
CARE MANAGEMENT:
  • Identify patients who have post-acute care, placement, and complex discharge planning needs based on a comprehensive assessment that includes physical, as well as psycho-social factors/needs.
  • Anticipate, initiate, and establish a discharge plan for patients with post-acute care needs, collaborating with the physician, nurse, and other health care providers, the patient, their family/primary caregiver(s), third-party payers, and employer following established clinical guidelines, standards, and pathways.
  • Review the admission assessment and collaborate with the primary nurse and other health care providers to ensure a multidisciplinary care plan is in place to meet identified patient care needs and desired outcomes.
  • Identify system issues that serve as barriers to care. Participates in the development and implementation of strategies to remove barriers and facilitate patient progression.
About Us
ChristianaCare is located in Delaware and is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs.
ChristianaCare includes an extensive network of primary care and outpatient services, home health care, urgent care centers, three hospitals (1,336 beds), a freestanding 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.
Christiana Care Offers
  • Medical, Dental, Vision, Life Insurance, Tuition assistance, etc.
  • Two retirement planning offerings, including 403(b) with company contributions.
  • Generous paid time off with annual rollover and opportunities to cash out.
  • 12-week paid parental leave
  • Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more!
Education & Requirements
  • An active RN license is required in DE or a Compact State.
  • A Bachelor of Science in Nursing (BSN) is required.
  • Candidates must have 3-5 years of acute care experience in a hospital setting.
  • In-patient case management experience is preferred.
  • 3-5 years of Acute Care Experience is required.
  • Basic Life Support (BLS) certification is preferred.
  • A Case Management Certification (CMC) must be obtained within 18 months of eligibility.

Hourly Pay Range: $41.28 - $66.05
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
Sep 30, 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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