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Utilization Case Manager Jobs in Delaware (NOW HIRING)

Easterseals Delaware

Center Administrator

New Castle, DE · On-site

$87K - $90K/yr

Primary contact for caregivers, case managers, and participants * Conduct annual case record ... Maintain utilization targets and ensure services align with budget * Participate in committees and ...

Dane Street

Otolaryngology Physician

Dover, DE

... utilization review/management expertise * Expanded credentials as an expert in Independent Medical Exams and physician advisor services * Fully prepped cases, streamlined case flow, transcription ...

Recovery Innovations

Shift Supervisor

Ellendale, DE · On-site

$34 - $37/hr

... including utilization and capacity management, supplies, meals and maintenance requirements ... case managers and other area programs. * Compliance amp; Risk Management: * Determines a ...

RI International

Shift Supervisor

Ellendale, DE · On-site

$34 - $37/hr

... including utilization and capacity management, supplies, meals and maintenance requirements ... members, friends, case managers and other area programs. * Compliance & Risk Management:

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Delaware

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 does a utilization case manager do?

A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.

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 jobs pay 4000 a week without a degree?

Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.

What is the highest paid case manager?

The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.

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.

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

Nursing Manager/Director, Operating Room

A24Group

Wilmington, DE • On-site

Full-time

Posted 14 days ago

Job description

Job Title:

Nursing Manager / Director – Operating Room

Location:

Wilmington, Delaware, United States

Job Type:

Full-Time

Shift:

  • Day shift, Monday through Friday

  • 9-hour shifts (4–5 days/week) or 10-hour shifts (4 days/week)

  • Some on-call weekends, holidays, and after-hours weekdays

  • PRN coverage once per week

Job Summary:

The Nursing Manager/Director – Operating Room is responsible for the coordination and oversight of daily operations within the surgical suite during daytime hours. The role ensures the efficient flow of surgical cases, optimal staffing, and adherence to patient safety, quality standards, and regulatory compliance. This position also provides leadership, mentorship, and administrative support to nursing and technical staff.

Key Responsibilities:

  • Supervise and support OR staff, assigning roles based on case complexity and staff competencies

  • Coordinate surgical case flow to reduce delays and enhance operational efficiency

  • Serve as a liaison among surgical teams, anesthesia providers, and support departments to ensure clear communication

  • Respond to emergent situations and reallocate resources to maintain patient safety and care quality

  • Ensure compliance with institutional policies, infection control protocols, and regulatory standards

  • Mentor and guide staff, fostering a collaborative and professional environment

  • Support efficiency initiatives to improve workflow, reduce turnover times, and enhance patient care delivery

  • Facilitate timely case starts, optimize room utilization, and minimize bottlenecks in perioperative services

  • Assist the Nurse Manager in overall administrative direction for clinical practice and delivery of high-quality care

  • Supervise daily staffing and scheduling needs of the department

  • Evaluate staff performance and counsel team members when performance issues are identified

  • Participate in hiring, promotion, salary adjustment, and termination decisions

  • Model quality expertise and professional behavior to support staff development and strategic goals

  • Identify and develop strategies to improve staff knowledge, integrity, and performance

  • Direct, mentor, and support all levels of staff on the floor

  • Engage in succession planning by identifying potential future leaders

  • Analyze operational functions and implement changes and system-wide improvements

  • Develop, implement, and supervise performance improvement and patient safety initiatives

Required Qualifications & Skills:

  • Bachelor’s or Master’s Degree in Nursing (Master’s required within 5 years of hire)

  • Registered Nurse (RN) license required

  • Operating Room (OR) experience required

  • Minimum of 5 years clinical and leadership experience

  • CNOR certification required (or completion within six months of start date)

  • Strong leadership, mentorship, and team-building skills

  • Excellent communication, organizational, and decision-making abilities

  • Ability to analyze operational workflows and implement performance improvement initiatives

  • Knowledge of regulatory compliance, infection control, and patient safety standards

Core Competencies:

  • Staff supervision and mentoring

  • Surgical case coordination and OR management

  • Patient safety and quality assurance

  • Workflow optimization and efficiency improvement

  • Performance evaluation and counseling

  • Succession planning and talent development

  • Compliance with institutional policies and regulatory standards

  • Leadership in emergent and high-pressure situations

  • Interdisciplinary collaboration with surgical and support teams