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Utilization Management Jobs in Delaware (NOW HIRING)

A-Line Staffing Solutions

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Registered Nurse Case Manager - LTSS

New Castle, DE · On-site

$37 - $40/hr

Utilization Management * Transition of Care * Member Assessments * Home Health Visits * Service Planning * Clinical Documentation * Community Resource Coordination * Healthcare Navigation * Medicaid ...

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$39K

$89.6K

$163.1K

How much do utilization management jobs pay per year?

As of May 28, 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 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 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 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.
More about Utilization Management jobs
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:
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Registered Nurse Case Manager - LTSS

Registered Nurse Case Manager - LTSS

A-Line Staffing Solutions

New Castle, DE • On-site

$37 - $40/hr

Full-time

Medical, Dental, Vision

This job post has expired today. Applications are no longer accepted.

Job description

Registered Nurse Care Manager – LTSS (Hybrid)

Pay: $37-40/hr
Schedule: Monday – Friday, 8:00 AM – 5:00 PM EST, No OT expectations
Location: New Castle County, Delaware
Employment Type: W2 6 Month Temp-to-hire, Potential for extension and possible conversion to FTE

Job Overview

We are seeking a Registered Nurse Care Manager to support Long-Term Services and Supports (LTSS) members through care coordination, level of care redeterminations, transition of care activities, and ongoing case management support. This role involves a combination of member home visits, care assessments, coordination with providers and caregivers, and documentation of care management activities to help ensure members receive appropriate services and support.

The RN Care Manager will work closely with the LTSS team to assist members with immediate needs, maintain compliance with level of care requirements, and coordinate services and resources based on individualized care plans.

Responsibilities

  • Complete LTSS level of care redeterminations and care assessments
  • Conduct member home visits and other site visits as needed
  • Coordinate transition of care and ongoing case management activities
  • Evaluate member needs, available resources, and support plans for appropriate outcomes
  • Assist with developing and maintaining long-term service plans and care plans
  • Coordinate services between members, caregivers, providers, specialists, and community resources
  • Support members and families with resource coordination related to housing, independent living, employment, foster care, participant direction, and other needs
  • Monitor member status, outcomes, and compliance with care plans and level of care requirements
  • Educate members and caregivers on healthcare services, benefits, referrals, and provider instructions
  • Maintain accurate documentation and ensure compliance with state, federal, and payer requirements
  • Collaborate with healthcare providers and internal care management teams
  • Provide feedback on opportunities to improve care delivery and service coordination
  • Support the LTSS team during periods of increased membership growth

Performance Expectations

  • Complete approximately 4–5 assessments per week
  • Complete approximately 4–5 redeterminations daily

Required Qualifications

  • Active Delaware RN License or Compact RN License
  • Associate's degree OR Bachelor’s degree and 2–4 years of related experience
  • Experience with:
    • Level of Care Redeterminations
    • Transition of Care
    • Case Management
  • Valid Driver’s License
  • Ability to travel for member home visits within Delaware
  • Dedicated home workspace for remote administrative work

Preferred Qualifications

  • Previous experience as a Service Care Manager
  • LTSS experience preferred

Skills & Experience

  • LTSS Case Management
  • Care Coordination
  • Utilization Management
  • Transition of Care
  • Member Assessments
  • Home Health Visits
  • Service Planning
  • Clinical Documentation
  • Community Resource Coordination
  • Healthcare Navigation
  • Medicaid / Managed Care
  • Interdisciplinary Collaboration
  • Patient Education
  • Compliance & Regulatory Documentation
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About A-Line Staffing Solutions

Sourced by ZipRecruiter

A-Line Staffing Solutions is an established full-service recruiting and staffing provider that operates in the industry of human resources and recruitment. Based in Utica, Michigan, A-Line Staffing Solutions has been committed to its mission of providing innovative and effective workforce solutions since its foundation. The company specializes in providing high-quality staffing solutions for a range of disciplines, including Information Technology, Professional, Administrative, Healthcare, and more. A-Line prides itself on its ability to offer comprehensive and tailored staffing solutions in line with the varying needs of different businesses, which has played a crucial role in the company's growth and success.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Utica, MI, US

Year founded

2004

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