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Utilization Review Np Jobs in Delaware (NOW HIRING)

The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for ... Facilitates patient/family conferences to review treatment goals, optimize resource utilization ...

Perform preoperative chart reviews for inpatient add‑on surgical patients. * Respond to questions ... Active NP/APRN licensure in the State of Delaware. * Current BLS and ACLS certifications.

Reviews all lab data and documents. Issues prescriptions to patients based on Federal & State ... Nurse Practitioner ; * Credential(s): Registered Nurse Nurse Practitioner Nurse Practitioner ...

The NP will work closely with anesthesiologists, the PEP/PAE team, surgical teams, and ... Perform preoperative chart reviews for inpatient add‑on surgical patients. * Respond to questions ...

Reviews all lab data and documents. Issues prescriptions to patients based on Federal & State ... Nurse Practitioner ; * Credential(s): Registered Nurse Nurse Practitioner Nurse Practitioner ...

Job Details Senior Nursing Students, Nurse Graduates and new RN's, it is time to apply for our ... review by residency coordinators Offers to be made once all scheduled interviews are completed.

$85K - $137K/yr

UTILIZATION MANAGEMENT * Performs admission and concurrent review to identify medical necessity ... Reviews the admission assessment and collaborates with primary nurse and other health care ...

$85K - $137K/yr

UTILIZATION MANAGEMENT * Performs admission and concurrent review to identify medical necessity ... Reviews the admission assessment and collaborates with primary nurse and other health care ...

Position: Nurse Practitioner Company: Medi-Weightloss of Hockessin, DE About Us: Are you a ... Obtain and review patient's medical and psychosocial history information relevant to patient care.

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Utilization Review Np information

What are some common challenges utilization review nurse practitioners face when collaborating with healthcare providers and insurance companies?

Utilization Review Nurse Practitioners often navigate the challenge of balancing patient advocacy with payer requirements. They must effectively communicate clinical justifications to both healthcare providers and insurance representatives, sometimes mediating disagreements over the necessity of certain treatments or hospital stays. Staying up-to-date with ever-changing insurance guidelines and ensuring timely documentation can also be demanding, but strong organizational and interpersonal skills help facilitate smooth collaboration and successful patient outcomes.

What does a utilization review nurse practitioner do?

A Utilization Review Nurse Practitioner (NP) evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance coverage to ensure that care meets established guidelines and regulatory requirements. Utilization Review NPs help coordinate care, prevent unnecessary procedures, and support cost-effective healthcare delivery while ensuring patient safety and quality outcomes.

What are the key skills and qualifications needed to thrive as a utilization review nurse practitioner, and why are they important?

To thrive as a Utilization Review Nurse Practitioner (NP), you need expert clinical judgment, a strong understanding of healthcare regulations, and advanced assessment skills, typically supported by an active NP license and clinical experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare and Medicaid are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for effective case evaluations and collaboration with providers. These competencies ensure accurate, efficient reviews that support quality care, compliance, and cost-effective treatment decisions.

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

AspectUtilization Review NpUtilization Review Nurse
CredentialsMaster's degree in Nursing, Nurse Practitioner certification, state licensureRegistered Nurse (RN) license, possibly with certification in utilization review
Work EnvironmentHealthcare facilities, insurance companies, utilization review organizationsHospitals, insurance companies, outpatient clinics
Job ResponsibilitiesAssess medical necessity, authorize treatments, make clinical decisions, often with greater autonomyReview medical records, support authorization processes, follow established guidelines

Utilization Review NPs typically have advanced clinical training and greater decision-making authority compared to Utilization Review Nurses. Both roles focus on evaluating medical necessity, but NPs often perform more complex assessments and can make independent recommendations, whereas nurses support the review process under supervision or guidelines.

What are popular job titles related to Utilization Review Np jobs in Delaware? For Utilization Review Np jobs in Delaware, the most frequently searched job titles are:
What cities in Delaware are hiring for Utilization Review Np jobs? Cities in Delaware with the most Utilization Review Np job openings:
Infographic showing various Utilization Review Np job openings in Delaware as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution.

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Job description

We're unique. You should be, too.

We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.

The Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare medical centers, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment or providing assessments to members in SNF and home settings. The responsibilities include but are not limited to: geriatric assessment, medical history, physical exam, diagnosis and treatment, development of the nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed standards for quality, service, productivity and teamwork. It also includes the participation in clinical rounds and conferences plus in-depth documentation through written progress notes and summaries.
The Nurse Practitioner must demonstrate the ability to function both independently and in collaboration with other health care professionals. Consults with the manager, physician, and medical director to ensure compliance with guidelines. This position may require participation in risk and quality management programs, clinical meetings and other meetings.
The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance, and policies and procedures.
Functions independently as a certified nurse practitioner for a patient population in collaboration and consultation with a licensed patient care team physician. Practices in accordance with a written or electronic practice agreement.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

  • Independently assesses acute and non-acute clinical problems. Performs and documents physical assessments and patient histories, analyzes trends in patient conditions, and develops, documents and implements a patient management plan in response to the data obtained. This also includes assisting in the development of the nursing plan of care in addition to providing appropriate patient/ family/significant other counseling and education.
  • Plans patient care based on in-depth knowledge of the specific patient population and/ or protocol, anticipating and identifying physiological and/ or psychological problems commonly encountered including the consideration of the patient's cultural background, level of understanding, personality and support systems. Serves as patient advocate.
  • Patient management includes the following:
  • Writes admission, transfers and discharges orders.
  • Orders and interprets appropriate laboratory and diagnostic studies.
  • Orders of appropriate medication and treatments.
  • Refers patients for consultation when indicated i.e. dermatology, neurology, ophthalmology, endocrine, surgery, intensive care, infectious disease, hematology, psychiatry, social service, dietary, etc.
  • Documentation through in-depth progress notes and summaries.
  • May perform invasive procedures independently upon the completion of documented competency.
  • Participates in patient care rounds and conferences. Communicates patient management strategies to members of the patient care team. Collaborates with members of the multidisciplinary team to ensure that patient management strategies are successful in meeting patient care needs.
  • Recognizes situations which require the immediate attention of a physician, and initiates life-saving procedures when necessary.
  • Uses advanced communication skills to problem solve complex situations and to improve processes and service to patients.

Other Responsibilities may include:

  • Collaborates with other multidisciplinary team members to analyze and evaluate current systems of health care delivery to identify and implement new practice patterns as appropriate.
  • Participates in outside activities that enhance personal and professional growth and development.
  • Initiates arrangements and writes orders for SNF discharges and completes appropriate paperwork.
  • Works collaboratively with physicians, nurses, PT, social workers, family and key caregivers to transition the patient to a lower level of care as soon as medically appropriate.
  • Introduces self to patient/family and explain nurse practitioner role.
  • Facilitates patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify post-SNF needs.
  • Enhances a collaborative relationship to maximize the patient's/family's ability to make informed decisions re: goals of care, palliative care and hospice.
  • Facilitates discharge to appropriate level of care and uses preferred providers when additional services are required.
  • Prescribes medication to patients based on State of practice.
  • Other duties as assigned and modified at manager's discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

  • Demonstrated record of consistently achieving clinical performance metrics in current role
  • Strong Critical Thinking and problem-solving skills
  • Excellent communication and interpersonal skills
  • Time management skills with the ability to work well under pressure
  • Must be caring and empathetic and have great listening skills
  • Must be detail-oriented, and able to pay close attention to patient charts, medications, and follow-up on details of patient care
  • Basic computer skills and some knowledge of Microsoft Office Suite
  • This position may require 50-75% of local travel

EDUCATION AND EXPERIENCE CRITERIA:

  • ARNP or similar advanced degree in Nursing required
  • A minimum of 1 year of clinical nurse practitioner experience
  • Current Nurse Practitioner Certification in the State of practice required
  • Board certification by AANP or ANCC is preferred but may be required for certain States
  • Current DEA number from the DEA for schedule II-V controlled substances may be required based on State of practice
  • Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required w/in first 90 days of employment

PAY RANGE:

$111,140 - $158,771 Salary

The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.

EMPLOYEE BENEFITS

https://chenmed.makeityoursource.com/helpful-documents

We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care.

ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day.

Current employees, if you want to apply to our internal career site, please click HERE

Current Contingent Worker please see job aid HERE to apply

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About ChenMed

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We're expanding healthcare equity across America. We're already in 15 states with 100+ medical centers. As a rapidly growing, physician-led organization, we have one central focus: rescue any and every senior from a healthcare system that has failed them. Our family of brands include Chen Senior Medical Center, JenCare Senior Medical Center, and Dedicated Senior Medical Center. Recently named a 2021 Best Places To Work and one of the only healthcare companies recognized in Fortune's 2020 "Change The World" list, ChenMed prides itself on creating a culture that enables career growth and promotes inclusion for all.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Miami, FL, US

Year founded

1985

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