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Utilization Case Manager Jobs in Delaware (NOW HIRING)

Christiana Care Health Services

$30.34 - $48.55/hr

... Case Manager - manage patient care and drive patient progression and establish a discharge plan. * Social Worker - resolve psycho-social barriers and supports discharge needs. * Utilization ...

CareSource

Medical Director

Dover, DE · On-site

$195 - $342/hr

Oversight and quality improvement activities associated with case management activities * Assist in the review of utilization data to identify variances in patterns, and provide feedback and ...

New

Powerback Rehab

Program Lead-PB Rehab PTA

Dover, DE · On-site

Ensures that the clinical management of the rehabilitation department, including oversight related to case management, quality improvement, care planning, clinical utilization, and patient ...

Christiana Care Health Services

$30.34 - $48.55/hr

... Case Manager - manage patient care and drive patient progression and establish a discharge plan. * Social Worker - resolve psycho-social barriers and supports discharge needs. * Utilization ...

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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.

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.

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 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 degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

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

Social Worker II - MSW - ED - Newark - 3p-11:30p - 15K Sign-On Bonus

Christiana Care Health Services

$30.34 - $48.55/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 21 days ago

ChristianaCare rating

7.8

Company rating: 7.8 out of 10

Based on 131 frontline employees who took The Breakroom Quiz

129th of 893 rated healthcare providers

Job description

Job Details

  • The successful candidate may be eligible for a $15,000 sign on bonus to be paid within first year of a two-year commitment.

    If you are an energetic, motivated, compassionate Social Worker that understands the importance of care coordination and who is seeking a work environment filled with Love and Excellence, ChristianaCare is where you want to be.

    ChristianaCare includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (over 1200 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.


    ChristianaCare Offers

  • Medical, Dental, Vision, Life Insurance, etc.
  • Two retirement planning offerings, including 403(b) with company contributions
  • Generous paid time off with annual roll-over and opportunities to cash-out
  • 12 weeks paid parental leave
  • Tuition assistance
  • Incredible Work/Life benefits including annual membership to care.com, access to backup care services for dependents through Care@Work, retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets and much more!
  • RN Case Manager - manage patient care and drive patient progression and establish a discharge plan.
  • Social Worker - resolve psycho-social barriers and supports discharge needs.
  • 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 following:

  • RN Case Manager - manage patient care and drive patient progression and establish a discharge plan.
  • Social Worker - resolve psycho-social barriers and supports discharge needs.
  • Utilization Management - review patient status for appropriateness and anticipated payer coverage.

  • EDUCATION AND EXPERIENCE REQUIREMENTS:

  • Master's degree in Social Work (MSW) or Master of Social Services degree (MSS) from an accredited graduate school required prior to hire date.
  • Licensed CSW or MSW as required by the state of Delaware prior to hire date.
  • Acute Care Social Work experience preferred.

  • SPECIAL REQUIREMENTS:

    CCM preferred within 18 months of eligibility.

Hourly Pay Range: $30.34 - $48.55This 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

Oct 3, 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 visithttps://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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