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Utilization Case Manager Jobs in Delaware (NOW HIRING)

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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:

Utilization Case Manager jobs near you

RN Unit Base Case Manager - Weekender - Sign-on Bonus

Christiana Care

Newark, DE • On-site

$40/hr

Other

Medical, Retirement, PTO

Re-posted 3 days ago

ChristianaCare rating

7.7

Company rating: 7.7 out of 10

Based on 129 frontline employees who took The Breakroom Quiz

157th of 887 rated healthcare providers

Job description

Job Details
RN Case Manager - Weekender - Day Shift
Saturday & Sunday (Hours: 8a-8:30p plus one rotating Friday shift (4p-8p).
Newark, DE
ChristianaCare - Newark Hospital is currently recruiting an RN Acute Care Case Manager - Weekender with experience in Transitional Care or Discharge Planning in an Acute Care Hospital Setting
As part of our Weekend Incentive Program (WIP), you will be required to work 3 out of 4 weekends in a four-week schedule. This includes a 12-hour day shift on Saturdays and Sundays, along with one rotating Friday shift. Additionally, there will be an annual rotating holiday every other year.
Weekend Incentive Program Includes: Special rate of pay and full benefits, except for Paid Time Off (PTO).
The RN Case Manager will be responsible for managing patient care, driving patient progression, and establishing a discharge plan. This includes functioning as a member of the interdisciplinary team, creating, implementing, and monitoring treatment plans to ensure safe, timely, and effective transitions throughout the care continuum and discharge planning.
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.
Education & Requirements
  • An active RN license in DE or a Compact State is required.
  • BSN required.
  • RN Case Manager experience in an inpatient hospital setting with a focus on acute care is required.
  • RN Case Manager with insurance companies experience, plus a background in acute care, will be considered.
  • BLS preferred.
  • Case Management Certification (CMC) is required within 18 months of eligibility.

This is a flat-rate position. With benefits, the WIP rate is $35 plus a $10 shift differential. Without benefits, the rate is $40 plus a $20 shift differential. WIP positions are merit eligible. 10K Sign-on Bonus
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

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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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