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Utilization Review Coordinator Jobs in Delaware (NOW HIRING)

Christiana Care Health Services

$85K - $137K/yr

Reviews the admission assessment and collaborates with primary nurse and other health care ... Monitors efficiencies in scheduling diagnostic procedures and coordination of treatments to ...

Christiana Care Health Services

$85K - $137K/yr

Reviews the admission assessment and collaborates with primary nurse and other health care ... Monitors efficiencies in scheduling diagnostic procedures and coordination of treatments to ...

SUN Behavioral Delaware

Intake Coordinator I

Georgetown, DE · On-site

$16.50 - $22.75/hr

Upon assessment of the patient, coordinates with the physician to ensure appropriate treatment is ... Demonstrates understanding of utilization review process to include treatment criteria and ...

SUN Behavioral Delaware

Intake Coordinator II

Georgetown, DE · On-site

$16.50 - $22.75/hr

Upon assessment of the patient, coordinates with the physician to ensure appropriate treatment is ... Demonstrates understanding of utilization review process to include treatment criteria and ...

SUN Behavioral Delaware

Intake Coordinator II

Georgetown, DE · On-site

$16.50 - $22.75/hr

Upon assessment of the patient, coordinates with the physician to ensure appropriate treatment is ... Demonstrates understanding of utilization review process to include treatment criteria and ...

SUN Behavioral Delaware

Intake Coordinator I

Georgetown, DE · On-site

$16.50 - $22.75/hr

Upon assessment of the patient, coordinates with the physician to ensure appropriate treatment is ... Demonstrates understanding of utilization review process to include treatment criteria and ...

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Utilization Review Coordinator information

See Delaware salary details

$15

$29

$46

How much do utilization review coordinator jobs pay per hour?

As of Aug 22, 2026, the average hourly pay for utilization review coordinator in Delaware is $29.63, according to ZipRecruiter salary data. Most workers in this role earn between $21.39 and $34.66 per hour, depending on experience, location, and employer.

What does a utilization review coordinator do?

A Utilization Review Coordinator is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and regulatory requirements. By coordinating between healthcare providers, insurance companies, and patients, Utilization Review Coordinators help optimize resource use and manage healthcare costs while ensuring quality patient care.

What skills and qualifications are needed to be a utilization review coordinator?

To thrive as a Utilization Review Coordinator, you need expertise in healthcare regulations, clinical guidelines, and case management, often supported by an RN license or a background in health administration. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance approval processes are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills ensure compliance, optimize resource use, and support quality care delivery within healthcare organizations.

How does a utilization review coordinator collaborate with healthcare providers and insurance companies?

A Utilization Review Coordinator regularly communicates with both healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. They review medical records and treatment plans, discuss cases with physicians to clarify medical necessity, and submit documentation to insurance payers for approval. This role requires strong interpersonal skills, as coordinators often need to negotiate coverage decisions and resolve discrepancies between clinical teams and insurers. Effective collaboration ensures timely authorizations and helps avoid unnecessary delays in patient care.

What is the difference between Utilization Review Coordinator vs Utilization Review Nurse?

AspectUtilization Review CoordinatorUtilization Review Nurse
CredentialsTypically requires a healthcare-related certification or associate degreeRegistered Nurse (RN) license required
Work EnvironmentOffice setting, administrative tasks, coordinationClinical setting, patient chart review, direct communication with healthcare providers
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Common Search & ComparisonFocuses on administrative review processesInvolves clinical assessment and patient care considerations

While both roles involve reviewing healthcare utilization, the Utilization Review Coordinator primarily handles administrative and coordination tasks, often without direct patient contact, whereas the Utilization Review Nurse performs clinical assessments as a licensed RN, often in hospital or clinical settings. Understanding these differences helps job seekers identify the right role based on their credentials and career goals.

What are the most commonly searched types of Utilization Review jobs in Delaware?

The most popular types of Utilization Review jobs in Delaware are:

What are popular job titles related to Utilization Review Coordinator jobs in Delaware?

For Utilization Review Coordinator jobs in Delaware, the most frequently searched job titles are:

What job categories do people searching Utilization Review Coordinator jobs in Delaware look for?

The top searched job categories for Utilization Review Coordinator jobs in Delaware are:

What cities in Delaware are hiring for Utilization Review Coordinator jobs?

Cities in Delaware with the most Utilization Review Coordinator job openings:

Utilization Review Coordinator jobs near you
Infographic showing various Utilization Review Coordinator job openings in Delaware as of August 2026, with employment types broken down into 100% Full Time. Highlights an 88% In-person, and 12% Remote job distribution, with an average salary of $61,638 per year, or $29.6 per hour.

Utilization Management Specialist I

SUN Behavioral Delaware

Georgetown, DE • On-site

Full-time

Posted 7 days ago

Sun Behavioral Health rating

6.2

Company rating: 6.2 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

Position Summary:
Responsible for the coordination of case management strategies pursuant to the Case Management process. Assists and coordinates care of the patient from pre-hospitalization through discharges. Responsible for assisting with authorization of admissions to hospital. Processes retroactive reviews and appeals, copies needed documentation and writes retro/appeal letters for insurance companies to ensure coverage for patient admissions. Conducts follow up calls with insurance companies to ensure coverage for patient admissions. Participates in performance improvement activities. Attends 80% of staff meetings. Coordinates care for patient through communication with Physicians, Nurse Practitioners, Clinical Services, Nursing, Assessment and Referrals Department.
Position Responsibilities:
Clinical / Technical Skills (40% of performance review)
  • Provides thorough documentation and timely updates regarding patient status on log sheets that are prepared for daily meetings concerning admissions, reviews and discharges; including case s with limited benefits, cases in peer review/denial and /or unplanned discharges
  • Coordinates with managed care companies or other third-party payors regarding peer reviews, retrospective reviews and appeals. Document s and updates the denial log to reflect same.
  • Consults Business Office and/or admission staff as needed to clarify data and ensure authorization processes are complete.
  • Documents in HCS the results of admission and concurrent reviews.
  • Stays informed about changes in Medicare and Medicaid.
  • Ability to stage local laws, ordinances and practices governing involuntary hospitalization and ensure compliance with same.
  • Reviews the quality of documentation for each level of care to ensure clinical effectiveness and appropriateness of treatment.
  • Maintains an active involvement and awareness of all patient admissions, discharges and transfers to alternate levels of care. Oversees continuity of care for each level of care transition.
  • Develops and maintains processes to minimize denials and communication of same to CFO and Business Office Director.
  • Reports results of daily treatment team meetings all discharges and status of high-risk case such as limited benefits, peer reviews, denials or unplanned discharges.
  • Timely retroactive reviews and appeals within current month
  • Strong knowledge of external review organizations (i.e.: Medicare/Managed Care/Medicaid) with knowledge of payor resources and planning.
  • Types and mails all correspondence in a timely manner.
  • Answers the telephone in a polite manner, Communicates information to the appropriate staff.
  • Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage.
  • Support discharge planning and utilization review when necessary
  • Perform other duties as required

Safety (15% of performance review)
  • Strives to create a safe, healing environment for patients and family members
  • Follows all safety rules while on the job.
  • Reports near misses, as well as errors and accidents promptly.
  • Corrects minor safety hazards.
  • Communicates with peers and management regarding any hazards identified in the workplace.
  • Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
  • Participates in quality projects, as assigned, and supports quality initiatives.
  • Supports and maintains a culture of safety and quality.

Teamwork (15% of performance review)
  • Works well with others in a spirit of teamwork and cooperation.
  • Responds willingly to colleagues and serves as an active part of the hospital team.
  • Builds collaborative relationships with patients, families, staff, and physicians.
  • The ability to retrieve, communicate, and present data and information both verbally and in writing as required
  • Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.
  • Demonstrates adequate skills in all forms of communication.
  • Adheres to the Standards of Behavior

Integrity (15% of performance review)
  • Strives to always do the right thing for the patient, coworkers, and the hospital
  • Adheres to established standards, policies, procedures, protocols, and laws.
  • Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
  • Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
  • Completes required trainings within defined time periods, as established by job description, policies, or hospital leadership
  • Exemplifies professionalism through good attendance and positive attitude, at all times.
  • Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
  • Ensures proper documentation in all position activities, following federal and state guidelines.

Compassion (15% of performance review)
  • Demonstrates accountability for ensuring the highest quality patient care for patients.
  • Willingness to be accepting of those in need, and to extend a helping hand
  • Desire to go above and beyond for others
  • Understanding and accepting of cultural diversity and differences

Education
  • Required: High school diploma or GED. CPR and hospital-selected de-escalation technique certification.
  • Preferred: Associates or Bachelors degree.
  • Maintains education and development appropriate for position.
  • May substitute experience for education

Experience
  • Required: One year of experience in a behavioral healthcare setting.
  • Preferred: Previous experience in a Utilization Management department or as a Mental Health Tech
  • May substitute education for experience

What Sun Behavioral Health employees say

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