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Utilization Case Manager Jobs in Delaware (NOW HIRING)

CASE MANAGER-HOURLY

Dover, DE ยท On-site

$18.25/hr

Case Manager - Residential Recovery ServicesHelp Individuals Build Independence, Recovery, and ... Community navigation and resource utilization * Support residents in building skills necessary for ...

LTSS Case Manager

Georgetown, DE

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical ...

The Nurse Case Manager (NCM)/Case Management RN is responsible for the coordination of care of ... Case management or utilization management certification (preferred) * Minimum of five (5) years of ...

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 ...

Utilization Management - Reviews patient status for appropriateness and anticipated payer coverage ... Case Management Certification (CMC) is required within 18 months of eligibility. This is a flat ...

RN Case Manager - Day Shift

Newark, DE ยท On-site

$41.28 - $66.05/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Management - Reviews patient status for appropriateness and anticipated payer coverage ... Case Management Certification (CMC) is required within 18 months of eligibility. Hourly Pay Range ...

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Utilization Case Manager information

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.

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 degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

What are the key skills and qualifications needed to thrive as a utilization case manager?

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.

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:

CASE MANAGER-HOURLY

Apis Services Inc

Dover, DE โ€ข On-site

$18.25/hr

Part-time

Posted 22 days ago


Job description

Case Manager – Residential Recovery ServicesHelp Individuals Build Independence, Recovery, and Community Connections

Are you passionate about supporting individuals on their journey toward recovery and independent living? Do you believe that every person deserves the opportunity to live a meaningful life in their community?

We are seeking a compassionate and dedicated Case Manager to join our Residential Services team. In this role, you will use Psychiatric Rehabilitation principles to help residents build skills, achieve personal goals, strengthen natural supports, and improve their overall quality of life.

As a Case Manager, you will serve as a trusted partner, advocate, and recovery coach while helping individuals navigate challenges and celebrate successes. If you are committed to person-centered care and empowering others, we encourage you to apply.


Position Summary

Under the supervision of the Resident Manager, the Case Manager is responsible for supporting residents through a recovery-oriented, Psychiatric Rehabilitation approach. The Case Manager promotes recovery, community integration, wellness, and independence by collaborating with residents, family members, treatment providers, and community resources.

This position helps create a safe, supportive, and empowering residential environment where individuals can develop life skills, strengthen natural supports, and work toward their personal recovery goals. The Case Manager also serves as a resource to team members by supporting the implementation of Psychiatric Rehabilitation principles and practices.


Essential ResponsibilitiesRecovery and Rehabilitation Support
  • Utilize Psychiatric Rehabilitation principles to promote recovery, personal growth, and community integration.
  • Assist residents in identifying, developing, and achieving individualized recovery goals.
  • Support residents in maintaining and improving their physical, emotional, and mental well-being.
  • Encourage active participation in individualized recovery planning and treatment activities.
  • Foster independence, self-confidence, and personal responsibility.
Resident Engagement and Support
  • Build trusting, supportive, and professional relationships with residents.
  • Provide encouragement, emotional support, and guidance while maintaining appropriate professional boundaries.
  • Assist residents in navigating daily challenges and achieving personal milestones.
  • Support residents in developing healthy coping skills and problem-solving strategies.
  • Promote participation in meaningful community, social, educational, and recreational activities.
Independent Living Skills Development
  • Educate and support residents in developing Independent Activities of Daily Living (IADLs), including:
    • Household management
    • Meal planning and preparation
    • Personal organization
    • Budgeting and money management
    • Scheduling and appointment management
    • Community navigation and resource utilization
  • Support residents in building skills necessary for successful independent living.
Advocacy and Empowerment
  • Encourage and model self-advocacy and personal empowerment.
  • Assist residents in accessing community resources, services, and supports.
  • Advocate for resident rights, choices, and recovery goals.
  • Support the development of natural support systems and community connections.
Residential Environment Support
  • Maintain a safe, welcoming, and recovery-focused living environment.
  • Assist with light housekeeping duties as needed to support a clean and healthy home.
  • Promote a collaborative and respectful atmosphere within the residence.
  • Monitor the residential environment and report safety or maintenance concerns as appropriate.
Team Collaboration and Documentation
  • Collaborate with residents, treatment providers, family members, and community partners to coordinate support services.
  • Participate in team meetings, case reviews, and treatment planning activities.
  • Maintain accurate, timely, and confidential documentation in accordance with organizational policies.
  • Support team members in understanding and implementing Psychiatric Rehabilitation practices.
Additional Responsibilities
  • Follow all operational procedures and organizational policies.
  • Attend required trainings, meetings, and professional development activities.
  • Perform additional duties as assigned by leadership to support program operations and resident success.

QualificationsRequired Qualifications
  • Bachelor's Degree in a Human Services discipline, including:
    • Human Services
    • Social Work
    • Psychology
    • Counseling
    • Sociology
    • Behavioral Health
    • Related field
  • Valid Driver's License with an acceptable driving record.
  • Strong interpersonal and communication skills.
  • Commitment to person-centered, recovery-oriented services.
Preferred Qualifications
  • Experience working with individuals experiencing mental health challenges.
  • Knowledge of Psychiatric Rehabilitation principles and recovery-oriented practices.
  • Experience in residential or community-based behavioral health services.

Core CompetenciesRecovery-Focused Practice

Ability to support individuals in achieving recovery, wellness, and community integration.

Relationship Building

Ability to establish trusting, respectful, and professional relationships with residents and stakeholders.

Advocacy and Empowerment

Commitment to promoting self-determination, independence, and resident choice.

Communication Skills

Strong verbal and written communication skills with diverse populations.

Team Collaboration

Ability to work effectively with interdisciplinary teams, families, and community partners.

Problem Solving

Ability to assess situations, identify needs, and implement appropriate supports and interventions.

Organization and Documentation

Ability to maintain accurate records, manage competing priorities, and meet deadlines.


Working Conditions

This position may involve work in residential, office, and community settings and may include exposure to:

  • Dust, fumes, and airborne particles
  • Extreme heat or cold
  • Wet or humid conditions
  • Loud noise levels
  • Confined spaces
  • Mechanical, chemical, electrical, and burn hazards

Travel within the community may be required to support resident needs and program activities.


Physical RequirementsPhysical Demand Level: Medium Work

This position requires:

  • Exerting up to 50 pounds of force occasionally
  • Exerting up to 20 pounds of force frequently
  • Exerting up to 10 pounds of force consistently
Physical Activities

The employee must be able to:

  • Sit or stand for extended periods
  • Walk frequently throughout residential and community environments
  • Use hands and fingers to handle and operate equipment and materials
  • Climb stairs and ladders as needed
  • Communicate effectively through speaking and listening
  • Visually assess environments, documentation, and resident needs
  • Push and pull materials or equipment
  • Reach above and below shoulder level
  • Kneel, stoop, crouch, and crawl when necessary

Why Join Our Team?

At RHD, we believe recovery is possible and that every person deserves the opportunity to live a fulfilling life in the community of their choice. As a Case Manager, you'll be part of a dedicated team that values compassion, respect, collaboration, and empowerment.

If you're looking for a rewarding career where you can make a meaningful difference every day, we invite you to join us.

Apply today and help individuals build the skills, confidence, and support systems needed to thrive.