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Utilization Case Manager Jobs in Delaware (NOW HIRING)

ChristianaCare

RN Case Manager - Outpatient

Wilmington, DE · On-site

$41.28 - $66.05/hr

The Case Manager will coordinate the utilization of healthcare resources, including planning transitions, facilitating the achievement of quality, clinical, financial, and member satisfaction goals.

Encompass Health

Certified Case Manager

Middletown, DE · On-site

The Certified Case Manager (CCM) serves as a key member of the interdisciplinary team and actively manages and directs resource utilization to achieve the highest quality outcomes during a patient ...

Apis Services Inc

ACT Case Manager

Claymont, DE · On-site

$19.50 - $25/hr

The Case Manager also manages case planning, utilization, data collection, and ongoing assessment to ensure clients receive the right level of care. RESPONSIBILITIES * Build relationships with ...

Apis Services, Inc.

ACT Team Case Manager

Dover, DE · On-site

$16 - $20.50/hr

The Case Manager also manages case planning, utilization, data collection, and ongoing assessment to ensure clients receive the right level of care. RESPONSIBILITIES * Build relationships with ...

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Registered Nurse Case Manager - LTSS

New Castle, DE · On-site

$37 - $40/hr

Coordinate transition of care and ongoing case management activities * Evaluate member needs ... Utilization Management * Transition of Care * Member Assessments * Home Health Visits * Service ...

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Utilization Case Manager information

What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

How does a Utilization Case Manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What is a Utilization Case Manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Delaware? For Utilization Case Manager jobs in Delaware, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Delaware look for? The top searched job categories for Utilization Case Manager jobs in Delaware are:
What cities in Delaware are hiring for Utilization Case Manager jobs? Cities in Delaware with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
RN Case Manager - Outpatient

RN Case Manager - Outpatient

ChristianaCare

Wilmington, DE • On-site

$41.28 - $66.05/hr

Full-time

Medical, Retirement, PTO

Posted 15 days ago

ChristianaCare rating

7.8

Company rating: 7.8 out of 10

Based on 123 frontline employees who took The Breakroom Quiz

131st of 864 rated healthcare providers

Job description

Job Details
RN Case Manager - Outpatient (CareVio)
M-F - (Hours: Hours: 8:00 am - 4:30 pm; on-call requirement per department schedule)
Site/Location: Christiana Care Primary Care Practice, site/location to be determined. Up to 4 days/week on-site is required, dependent on the practice.
Case Manager (RN) is responsible for the coordination of care for a complex patient population with medical and social determinants of health needs. The Case Manager works to improve outcomes and reduce preventable readmissions. The Case Manager will coordinate the utilization of healthcare resources, including planning transitions, facilitating the achievement of quality, clinical, financial, and member satisfaction goals.
Principal Duties & Responsibilities:
  • Perform ongoing telephonic case management activities of assessment, problem identification, planning, implementation, coordination, monitoring, and evaluation of case managed members.
  • Collaborates with patients, caregivers, and members of the multi-disciplinary care team to develop a member centered plan of care to meet identified member care goals and outcomes.
  • Develop, implement, evaluate, and revise case management care plans according to case management eligibility criteria, contractual guidelines and members physical and psychological needs throughout the continuum of care.
  • Identifies system issues that serve as barriers to care. Participates in development and implementation of strategies to remove barriers and promote resolution through coordination of a problem-solving process.
  • Promote member wellness and autonomy through advocacy, communication, education, and identification and referral to community resources or other case management programs such as disease management programs.
  • Identify appropriate providers and facilities through the continuum of services and ensure that available resources are being used in a timely and cost-effective manner.
  • Collaborate with transitional, embedded, and inpatient case managers in the discharge and transitional care process, obtaining and/or coordinating appropriate resources for members throughout the continuum of care.
  • Stratifies and/or validates member level of risk during each transition process and interaction with the member.
  • Collaborate with health care providers in settings not limited to the PCP office, hospital, skilled nursing facility or home care agencies to assist members in coordinating safe transitions and enhanced communication of the treatment plan to all members of the multidisciplinary care team.

Education & Requirements:
  • Registered Nurse with BSN required or relevant experience in Utilization Management or Case Management
  • DE RN License or Compact Licensure.
  • Ability to obtain a non-compact state RN Licensure as needed.
  • Basic Life Support (BLS) certification required.
  • Case Management Certification is preferred through the Commission for Case Management (CCM) within 18 months of eligibility.
  • Advanced Certification recommended.

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
May 29, 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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