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Utilization Review Np Jobs in Delaware (NOW HIRING)

... cases, reviewing full work-related incident and prescribing appropriate plan of care. Documents ... Nurse Practitioner NP - CSR (if required by defined job duties) Basic Life Support Registered Nurse ...

The Nurse Practitioner works within a collaborative model to provide quality care and to improve ... cases, reviewing full work-related incident and prescribing appropriate plan of care. Documents ...

The Nurse Practitioner works within a collaborative model to provide quality care and to improve ... cases, reviewing full work-related incident and prescribing appropriate plan of care. Documents ...

Overview Nurse Practitioner / NP, Palliative Care Location: Seaford, DE Position: Nurse ... Maintain communication with the supervisory physician (s) and attending physician to review patient ...

Trauma Team, NP/PA

Newark, DE · On-site

$121K - $150K/yr

Both the surgical management and medical management can be accomplished through utilization of ... Acute Care NP license required Experience in the acute care setting preferred. ACLS required Annual ...

Trauma Team, NP/PA

Newark, DE · On-site

$121K - $150K/yr

Both the surgical management and medical management can be accomplished through utilization of ... Acute Care NP license required Experience in the acute care setting preferred. ACLS required Annual ...

Nurse Practitioner Palliative Care Job ID: 76621 Remote/Virtual Position: No Find Your Passion and ... Maintain communication with the supervisory physician (s) and attending physician to review patient ...

Trauma Team, NP/PA

Newark, DE · On-site

$121K - $150K/yr

Both the surgical management and medical management can be accomplished through utilization of ... Acute Care NP license required Experience in the acute care setting preferred. ACLS required Annual ...

Showing results 21-40

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.

Nurse Practitioner (NP)

SUN BEHAVIORAL HEALTH GROUP

Georgetown, DE • On-site

Full-time

Re-posted 8 days ago


Job description

Position Summary:

Provides psychiatric and/or medical services to assigned patients

Position Responsibilities:

Clinical / Technical Skills (40% of performance review)

  • Demonstrates ability to provide quality patient care in a supportive and empathetic manner to ensure a safe environment.
  • Demonstrates ability to complete the psychiatric evaluation and/or History and Physicals and continued consult on medical issues and/or psychiatric needs, on all assigned patients. Psychiatric Evaluations must be completed within 24 hours of admission, and all History and Physical exams must be completed within 24 hours, as well as any other documentation.
  • Demonstrated ability to document all patient consultations in progress/EMR notes.
  • Demonstrates ability to complete documentation and maintain compliance with the policies and procedures.
  • Demonstrates ability to work collaboratively with the patient and treatment team to determine the best course of treatment and establish that course/interventions on the treatment plan. Attends treatment team for patients as scheduled and contributes to the plan of care for assigned patients.
  • Demonstrates ability to oversee medication regimens, needs for patients and prescribe medication appropriate to the patient within the needs of the patient, while considering past history, co-morbidities and contraindications.
  • Demonstrates ability to plan care for the patient by review of all non-psychiatric medical orders and/or psychiatric orders and prescriptions and consults with the attending psychiatrist and/or medical physician as needed.
  • Demonstrates ability to communicate risks, benefits and side effects of psychiatric medication to patients and documents such education in progress notes/EMR.
  • Perform other duties as assigned.

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: Graduation from an accredited Nurse Practitioner Program. Licensed with the State Board of Nursing in state of employment. DEA number. CPR and hospital-selected de-escalation technique certification.
  • Maintains education and development appropriate for position.
  • May substitute experience for education

Experience

  • Preferred: One (1) year of experience in a behavioral healthcare setting for Psychiatric Nurse Practitioners and One (1) year of experience for Nurse Practitioners that oversee the medical status of the patient.
  • May substitute education for experience