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Utilization Case Manager Jobs in Delaware (NOW HIRING)

Apis Services Inc

ACT Team Case Manager

Dover, DE · On-site

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 ...

Vivian Health

RN Case Manager in Newark, DE

Newark, DE

$41.28 - $66.05/hr

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 ...

Vivian Health

RN Case Manager in Newark, DE

Newark, DE

$41.28 - $66.05/hr

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 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
ACT Team Case Manager

ACT Team Case Manager

Apis Services Inc

Dover, DE • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 26 days ago

Job description

We’re Hiring at Conexio!

Case Manager

Program: ACT

Location: Kent County

Status: Full-Time - 40 hours

Schedule: M-F 8a-4p

ABOUT THE ROLE


The Case Manager is a bachelor’s-level paraprofessional responsible for providing assertive outreach, service linkage, benefits assistance, referrals, and housing services for homeless adults with behavioral health challenges. This role facilitates program admissions and discharges, monitors client eligibility, and ensures appropriate services are provided. 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 clients and encourage community involvement and independence.
  • Ensure health, safety, and well-being of clients by adhering to internal policies and state regulations.
  • Meet visitation and treatment compliance goals; complete CHCC forms for admissions.
  • Attend treatment team meetings and residential house meetings as needed.
  • Complete required documentation (progress notes, recovery plans, assessments) accurately and on time.
  • Respond to crises and ensure immediate service increases when needed.
  • Coordinate benefits applications and liaise with state agencies and service providers.
  • Act as an ombudsman for community and state services; manage complaints and referrals.
  • Facilitate transitions between inpatient, outpatient, and other care levels.
  • Participate in on-call crisis response on a rotating basis.
  • Perform other duties as assigned.

REQUIREMENTS

  • Bachelor’s degree in psychology, counseling, human services, social work, nursing, rehabilitation, or related field OR high school diploma with 5 years of experience.
  • Experience working with individuals with severe mental illness and/or substance abuse.
  • Experience in data collection and evaluation.
  • CPR and First Aid certification.
  • Valid driver’s license with at least 3 years of continuous driving experience and a clean record.

ADDITIONAL QUALIFICATIONS

  • Computer skills (MS Office preferred).
  • Strong verbal and written communication skills.
  • Excellent organizational and follow-up skills.
  • Ability to work independently and collaboratively.
  • Experience with underserved populations preferred.

BENEFITS

  • Full-time employees are eligible to
  • Medical, Dental, and Vision benefits
  • 401k, Life, Disability Insurance
  • Generous Paid Time Off (PTO)
  • Paid Training, Career Advancement
  • DailyPay - A benefit that allows you to access your pay when you need it
  • HSA, FSA
  • Life Assistance Program
  • A Great Team Environment
  • Competitive Wages
  • Wellness Program

ABOUT APIS AND THE AFFILIATE

APIS

Apis Services, Inc. (a wholly owned subsidiary of Inperium, Inc.) provides a progressive platform for delivering Shared Services to Inperium and its Constellation of affiliate companies. Allowing these entities to advance their mission and vision. By exploring geographical program expansion and focusing on quality outcome measures to create cost savings that result in reinvestment into the organization's stakeholders through capacity creation and employee compensation betterment.

Apis Services, Inc. and affiliates provide equal employment opportunities for all employees and applicants for employment in compliance with all federal and all applicable state and local laws and regulations, including nondiscrimination in hiring and employment. All employment decisions are made without regard to race, color, religion, gender, national origin, ancestry, age, sexual orientation, gender identity and expression, disability, genetic information, marital status, pregnancy/childbirth, veteran status or any other basis protected by law. This policy of non-discrimination and equal employment opportunities extends to every phase and aspect of hiring and employment.

CONEXIO CARE, INC.

Conexio Care, an affiliate of Apis Services, was founded in 1985 as a subsidiary of the organization then known as Church Home Foundation. Conexio’ s original mission was to help older adults with lifelong histories of psychiatric hospitalization to transition into the community. Our mission expanded in 1988 to include homeless services and substance abuse treatment. Today, Conexio Care serves as one of Delaware’s largest nonprofits, collaborating with government, community, corporate, and other philanthropic partners to maximize services for our state’s most vulnerable citizens. (Conexio Care https://conexiocare.org)