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Utilization Management Jobs in Delaware (NOW HIRING)

Evolent

Field Medical Director, Vascular Surgeon

Dover, DE · On-site

$130 - $140/hr

As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...

Christiana Care Health Services

$30.34 - $48.55/hr

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 ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE

Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. * Previous utilization and/or quality ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health care including HMO, PO and POS plans strongly preferred. * Previous utilization and/or quality ...

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Utilization Management information

See Delaware salary details

$39K

$89.6K

$163.1K

How much do utilization management jobs pay per year?

As of Jul 22, 2026, the average yearly pay for utilization management 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 are the key skills and qualifications needed to thrive in the Utilization Management position, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is a Utilization Management job?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a Utilization Management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the most commonly searched types of Utilization Management jobs in Delaware? The most popular types of Utilization Management jobs in Delaware are:
What are popular job titles related to Utilization Management jobs in Delaware? For Utilization Management jobs in Delaware, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Delaware look for? The top searched job categories for Utilization Management jobs in Delaware are:
What cities in Delaware are hiring for Utilization Management jobs? Cities in Delaware with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Delaware as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $89,560 per year, or $43.1 per hour.
Utilization Management Nurse

Utilization Management Nurse

Nemours Children's Health

Wilmington, DE • On-site

Full-time

Posted 21 days ago

Nemours Children's Health rating

8.1

Company rating: 8.1 out of 10

Based on 86 frontline employees who took The Breakroom Quiz

68th of 888 rated healthcare providers

Job description


Nemours is seeking a Full-Time Utilization Management RN to join our team in Wilmington, DE! The Utilization Management Nurse is responsible for the monitoring patient plan of care for timely completion and efficient use of resources by facilitating diagnostic and treatment services, tests, consultations and procedures. Oversees appropriateness of care using pre-established, health industry standards ensuring the appropriate allocation and use of hospital resources. Facilitates patient flow during the inpatient stay, identifies and proactively addresses potential denials of payment. Ensures timely and efficient patient throughput of assigned patient populations. Identifies barriers and works collaboratively with the medical and ancillary teams to resolve and expedite safe discharge. Ensures all regulatory requirements related Delaware, New Jersey, Pennsylvania, Maryland and other state agencies are met/updated; further guarantees that care is aligned with:
  • The Joint Commission (TJC)
  • Centers for Medicare/Medicaid Services
  • American Case Management Association Standards of Practice and Scope of Services (ACMA)

The Utilization Management Nurse is accountable for adherence to policies and procedures of Nemours Children's Hospital, Delaware Valley, and other affiliated hospitals to which Nemours-delegated patients are admitted/seek care. The Utilization and Nurse Case Management Manager is expected to maintain all state and federal clearances for DE.
Essential Functions:
  1. Conducts initial clinical reviews within 24 hours of patient admission. All reviews are to follow unit standards as per UM concurrent review guidelines.
  2. Provides concurrent admission, continued stay and retrospective review to insurance company staff as contractually required.
  3. Communicates anticipated Length of Stay and insurance review results to interdisciplinary team. Participates in interdisciplinary rounds as indicated.
  4. Identifies patients who do not meet current patient class criteria and takes action to communicate and change to appropriate level of care as indicated with attending physician and interdisciplinary team.
  5. Converts observation to admission and, conversely, admission to observation status; communicates change to team and others as needed.
  6. Mediates between physicians and insurance companies to avoid denials by monitoring patient plan of care and intervening as needed to assure timely completion of care at appropriate level of care.
  7. Facilitates the timely completion of diagnostic tests, procedures and treatment services, consultations and discharge planning activities in collaboration with the case management staff.
  8. Monitors payer authorization for continued stay
  9. Collaborates with patient care team to ensure efficient patient throughput. Communicates length of stay authorizations and barriers to discharge to unit based team daily; working within the team to identify and resolve issues.
  10. Monitors and facilitates correct patient class and accommodation codes via the EMR for every patient.

11. Adheres to and participates in revisions to all policies and procedures within the department.
Qualifications:
  1. BSN Degree required
  2. RN licensure in the state of DE required
  3. 5+ years of related experience

About Us
Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. We deliver care across six states through two freestanding children's hospitals - Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida - along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships.
Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit system is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child thrive.
Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.
Learn more at Nemours.org.

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About Nemours Children's Health

Sourced by ZipRecruiter

Nemours Children’s Health, situated in Rockland, Delaware, US, operates within the healthcare industry. The company is a prominent health system offering pediatric care in Delaware, New Jersey, Pennsylvania, and Florida. It was founded in 1936 by Alfred I duPont, philanthropist and industrialist, to improve the health of children. The core values of Nemours include quality, accountability, respect, and teamwork. Its mission is to provide leadership, institutions, and services to restore and foster a healthy tomorrow for children. The non-profit organization is unique in that its primary focus is on patient families, ensuring the highest standards of pediatric care. Notably, Nemours is consistently ranked among the top children's hospitals in the US and has its own renowned research center, the Nemours Biomedical Research.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Rockland, DE, US

Year founded

1936

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