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Utilization Management Nurse Jobs in Delaware (NOW HIRING)

UHS

PRN Utilization Management Coordinator

Dover, DE · On-site

... Diem Utilization Management Coordinator position. In this role, you will proactively monitor ... MSW or MS in a recognized mental health field or a Registered Nursing License * One (1) year ...

UHS

Lead UR Coordinator

Dover, DE · On-site

... Nursing License * One (1) year experience in case management and/or hospital experience Preferred: * One (1) year experience as a Utilization Management Coordinator at a long-term care facility About ...

UHS

Lead UR Coordinator

Dover, DE · On-site

... Nursing License * One (1) year experience in case management and/or hospital experience Preferred: * One (1) year experience as a Utilization Management Coordinator at a long-term care facility About ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Newark, DE · On-site +1

$56 - $68.25/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Dover, DE · On-site +1

$57.25 - $69.75/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

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Utilization Management Nurse information

See Delaware salary details

$39K

$89.6K

$163.1K

How much do utilization management nurse jobs pay per year?

As of May 28, 2026, the average yearly pay for utilization management nurse in Delaware is $89,560.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,600.00 and $104,600.00 per year, depending on experience, location, and employer.

What Does a Utilization Management Nurse Do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

What are the key skills and qualifications needed to thrive as a Utilization Management Nurse, and why are they important?

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What are some common challenges a Utilization Management Nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

What is a Utilization Management Nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

What is the difference between Utilization Management Nurse vs Case Manager?

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

More about Utilization Management Nurse jobs
What are the most commonly searched types of Utilization Management Nurse jobs in Delaware? The most popular types of Utilization Management Nurse jobs in Delaware are:
What are popular job titles related to Utilization Management Nurse jobs in Delaware? For Utilization Management Nurse jobs in Delaware, the most frequently searched job titles are:
What job categories do people searching Utilization Management Nurse jobs in Delaware look for? The top searched job categories for Utilization Management Nurse jobs in Delaware are:
What cities in Delaware are hiring for Utilization Management Nurse jobs? Cities in Delaware with the most Utilization Management Nurse job openings:
What are popular job titles related to Utilization Management Nurse jobs in DE? For Utilization Management Nurse jobs in DE, the most frequently searched job titles are:
Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Delaware as of May 2026, with employment types broken down into 3% As Needed, 28% Full Time, 65% Part Time, 3% Temporary, and 1% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $89,560 per year, or $43.1 per hour.

PRN Utilization Management Coordinator

Alan B. Miller Medical Center

Dover, DE

Per diem

Posted 20 days ago

Job description

Per Diem Utilization Management Coordinator

Dover Behavioral Health System is a 104-bed, acute care psychiatric hospital located in the beautiful Dover, Delaware area. Dover Behavioral Health System features individual units for adolescents and adults and offers inpatient acute care, partial hospitalization, and intensive outpatient programs. On average, over 10,000 patients receive care from our compassionate health care team each year at Dover Behavioral Health System. This opportunity offers working at a hospital known for its outstanding patient satisfaction, including ranking 6th for highest patient satisfaction in 2020 compared to over 200+ psychiatric hospitals. We attribute this success to our talented and dedicated staff. Dover Behavioral Health system is seeking qualified candidates for our Per Diem Utilization Management Coordinator position. In this role, you will proactively monitor utilization of continuum services and optimize reimbursement. Responsibilities will include:

  • Conduct admission reviews working with Assessment and Referral Services to stay abreast of admissions.
  • Conduct concurrent and extended stay reviews on appropriate day and/or specified time.
  • Prepare and submit appeals to third party payors, effectively coordinating collection of all pertinent data to support the hospital and patient's position.
  • Call/fax discharge information to insurance companies within 24 hours of discharge to ensure the facility is paid for the hospital stay.
  • Maintain and update logs of review and maintain other appropriate records of the Utilization Review department.
  • Communicate pertinent third party payors issues to doctor and treatment team.
  • Attend daily treatment team meetings to discuss acuity issues, third party payors needs and gather information for reviews.
  • Work independently in gathering information for reviews from the patient record, taking the initiative to seek information from members of the treatment team.
  • Understand and communicate insurance information to team members, including benefits and levels of care offered.
  • Perform internal utilization reviews as indicated.
  • Identify, document, and report any and all instances of adult or child abuse and neglect to the appropriate parties including a member of management, the police, and state agencies

Qualifications Minimum: MSW or MS in a recognized mental health field or a Registered Nursing License One (1) year experience in case management and/or hospital experience Preferred: One (1) year experience as a Utilization Management Coordinator at a long-term care facility

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