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Utilization Care Manager Jobs in Delaware (NOW HIRING)

$30.34 - $48.55/hr

Utilization Management - review patient status for appropriateness and anticipated payer coverage. * THE CARE MANAGEMENT MODEL: Our Care Management Triad Team Model is a collaboration between the ...

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. CARE MANAGEMENT : * Identify patients who have post-acute care, placement, and complex discharge ...

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

... 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 ...

Showing results 21-40

Utilization Care Manager information

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 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.

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 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 cities in Delaware are hiring for Utilization Care Manager jobs? Cities in Delaware with the most Utilization Care Manager job openings:
Infographic showing various Utilization Care Manager job openings in Delaware as of August 2026, with employment types broken down into 2% As Needed, 69% Full Time, 22% Part Time, and 7% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Ambulatory Care Nurse - RN Part-Time

Westside Family Healthcare Inc

Wilmington, DE • On-site

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago


Job description

Description

WESTSIDE IS LOOKING FOR NURSES!

LOAN REPAYMENT PROGRAM AVAILABLE!


JOIN A CARING, DEDICATED NURSING TEAM MAKING A DIFFERENCE IN OUR COMMUNITIES!

Westside Family Healthcare is a nonprofit organization that provides high quality primary medical care. The Ambulatory Care Nurse is an on-site RN serving as an integral member of the patient care team, supporting assigned care teams by managing high and rising risk patients, coordinating services throughout the continuum of care and serves as the in-office nurse. The Ambulatory Care RN supports patients by facilitating implementation of the prescribed medical treatment plan through patient-centered education of disease processes and wellness opportunities and through patient self-management skill development. The nurse process and established protocols will be used to coordinate the delivery of care consistent with a team-based, patient-centered approach to provide health services and education to patients and families through effective partnership with patient's medical home team, community resources, medical professionals, pharmacies and the Westside Family Healthcare organization. The Ambulatory Care RN will provide safe, therapeutic, efficient, quality care in all patient interactions. 


Since opening our doors in 1988, Westside has been driven by our mission to improve the health of our communities by providing equal access to quality healthcare. With 240 team members, five health centers, one mobile health unit and over 27,000 patients all across Delaware, Westside is committed to improving health, one patient, one family, one community at a time.  


WORKING AT WESTSIDE MEANS WORKING IN A PRIMARY CARE MEDICAL HOME

A Primary Care Medical Home is not a special building. It is a way to provide healthcare that puts the patient at the center of health care decision-making. As a community health center, Westside Family Healthcare provides care for everyone who walks through our doors.  

Our Mission: To improve the health of our communities by providing equal access to quality healthcare

Our Vision: Achieve health access for all

Our Values:

  • Compassion: Lead with compassion
  • Service: Serve with humility
  • Excellence: Be exceptional
  • Empowerment: Empower all people

OUR BENEFITS: Our benefit package includes medical insurance (two plans to choose from), dental insurance (through Guardian Dental), vision insurance, life insurance paid by Westside with the option to purchase more paid, short-term disability paid for by Westside, long term disability paid by the employee, a 401(k) retirement plan with a match, and supplemental insurances. We offer a generous PTO package and flexibility to provide work/life balance. Westside Family Healthcare is an Equal Opportunity Employer that values diversity. 


RESPONSIBILITIES OF NURSES

  1. Manage a caseload of patients identified as at risk for health deterioration, sentinel events and/or poor outcomes using the nursing process and established protocols/workflows. Ongoing evaluation of care coordination efforts by measuring interventions effectiveness and fostering a continuous improvement mentality. Partners with the patient and family, the primary care provider, and other team members to implement an interdisciplinary plan of care. 
  2. Participates in daily huddles with the Clinical Operations team, and other team meetings/trainings as scheduled 
  3. Proactively and continuously reviews patient medical records to identify any care needs requiring intervention or follow up during patient interactions 
  4. Works with patients and families to ensure both medical and psychosocial needs are met in order to promote health and well-being and to identify any barriers that inhibit the patient from adhering to the prescribed plan of care 
  5. Educates patient/family about medical conditions (existing or newly diagnosed) to assist them in appropriate self-management 
  6. Proactively incorporates lifestyle improvement opportunities and preventative care into patient interactions, empowering patients to reach their individual health goals 
  7. Assesses and documents progress towards goals based on provider's plan of care; utilizing clinical judgment, established protocols, review of patients' self-monitory tools and trends in clinical data (i.e., HbA1c, LDL, BP) 
  8. Promotes timely access to appropriate care, increasing the utilization of preventative care and healthy behaviors to improve the health of the population at risk 
  9. Provides ambulatory care support as a member of the care team, which may include, but is not limited to walk-in and/or telephone triage utilizing established protocols 
  10. Proactively advocates for patient care issues to ensure overall quality and adherence to provider's plan of care; ensuring care is sensitive to each specific patient's needs 
  11. Participates in quality improvement activities and initiatives
  12. Maintains compliance with all professional and organization requirements to meet position standards 


PM22

Requirements

MINIMUM OBJECTIVE QUALIFICATIONS

  1. Graduate of an accredited nursing program with an associate degree in Nursing
  2. Active RN licensure in the State of Delaware (or compact state) with no restrictions or disciplinary action
  3. Current BLS certification