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Utilization Review Nurse Jobs in Delaware (NOW HIRING)

RN Admissions

New Castle, DE ยท On-site

$39.53 - $43.66/hr

... utilization review processes to assure continuity for the most appropriate level of care for ... Clear and active nursing license in the state. * CPR and de-escalation/restraint certification ...

RN Admissions Part Time

New Castle, DE ยท On-site

$39.53 - $43.66/hr

... utilization review processes to assure continuity for the most appropriate level of care for ... Clear and active nursing license in the state. * CPR and de-escalation/restraint certification ...

RN Admissions Part Time

New Castle, DE ยท On-site

$39.53 - $43.66/hr

... utilization review processes to assure continuity for the most appropriate level of care for ... Clear and active nursing license in the state. * CPR and de-escalation/restraint certification ...

Intake Coordinator III

Georgetown, DE ยท On-site

$16.50 - $22.75/hr

... N for additional review and action. * States the working definition and procedure for managing ... Demonstrates understanding of utilization review process to include treatment criteria and ...

Intake Coordinator III

Georgetown, DE ยท On-site

$16.50 - $22.75/hr

... N for additional review and action. * States the working definition and procedure for managing ... Demonstrates understanding of utilization review process to include treatment criteria and ...

Intake Coordinator II

Georgetown, DE ยท On-site

$16.50 - $22.75/hr

... N for additional review and action. * States the working definition and procedure for managing ... Demonstrates understanding of utilization review process to include treatment criteria and ...

Intake Coordinator II

Georgetown, DE ยท On-site

$16.50 - $22.75/hr

... N for additional review and action. * States the working definition and procedure for managing ... Demonstrates understanding of utilization review process to include treatment criteria and ...

Intake Coordinator I

Georgetown, DE ยท On-site

$16.50 - $22.75/hr

... N for additional review and action. * States the working definition and procedure for managing ... Demonstrates understanding of utilization review process to include treatment criteria and ...

Intake Coordinator I

Georgetown, DE ยท On-site

$16.50 - $22.75/hr

... N for additional review and action. * States the working definition and procedure for managing ... Demonstrates understanding of utilization review process to include treatment criteria and ...

Licensed Practical Nurse (LPN)

Dover, DE ยท On-site

$24.75 - $33.75/hr

Review referrals requiring nursing judgment and maintain accurate referral statuses and ... Referral management, utilization management, case management, or ambulatory care preferred.

Showing results 21-40

Utilization Review Nurse information

See Delaware salary details

$21

$42

$69

How much do utilization review nurse jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for utilization review nurse in Delaware is $42.32, according to ZipRecruiter salary data. Most workers in this role earn between $33.46 and $48.61 per hour, depending on experience, location, and employer.

What does a utilization review nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What does a utilization review nurse do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

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

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What is the difference between Utilization Review Nurse vs Case Manager?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

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

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

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

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

What are popular job titles related to Utilization Review Nurse jobs in DE?

For Utilization Review Nurse jobs in DE, the most frequently searched job titles are:

Infographic showing various Utilization Review Nurse job openings in Delaware as of August 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 100% In-person job distribution, with an average salary of $88,022 per year, or $42.3 per hour.

$39.53 - $43.66/hr

Full-time

Medical, Dental, Vision

Posted 23 days ago


Job description

Overview

MeadowWood Behavioral is adding an RN's in Admissions to our team!

Available Shifts and Hours:ย 

  • Sunday through Thursday 11:00pm-7:00am

  • RN base pay: $39.53-$43.66/hr, based on experience
  • Shift differential:ย $2.75-$7.00/hour, depending on shift

Are you ready to take the next step in your nursing career at the premier mental health treatment center in New Castle, Delaware?

If so, MeadowWood Behavioral Health Hospital is the fit you are looking for. A career in behavioral healthcare can be a personally and professionally rewarding experience. At MeadowWood Behavioral Health Hospital, you will grow your skills and learn from leaders who take a hands-off approach to management. Through comprehensive training and personalized support, you will gain the foundation you need to reach your career goals.

MeadowWood Behavioral Health, a 120 bed treatment center providing services to adults and adolescents on both an inpatient and outpatient basis, is located on Rt. 13 in New Castle, Delaware.

*New Grads welcome to apply*

At Acadia Healthcare, we offer a comprehensive benefits package including medical, prescription drug plan, flexible spending accounts, health savings accounts, vision, dental, and voluntary short-term and long-term disability coverage. Additionally, our well-being programs encompass employee assistance programs, financial support, tuition reimbursement, and much more.

  • RN base pay: $39.53-$43.66/hr, based on experience
  • Shift differential:ย $2.75-$7.00/hour, depending on shift
  • Referral Bonus
  • Tuition Reimbursement
  • Flexible Scheduling
  • Excellent training program and career advancement opportunities

PURPOSE STATEMENT:

Clinical professional is responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care for patients and their benefit/resource utilization.

Responsibilities
  • Review medical documentation for all admissions, complete medication reconciliation, and obtain admission orders from physicians.
  • Facilitate emergency transfers for patients presenting with emergency medical conditions outside of the facility's capabilities.
  • Review referrals from hospitals, facilities, and other community agencies for medical and behavioral acuity and respond within facility policy timeframes.
  • Respond to inquiries about the facility and provide appropriate recommendations.
  • Conduct assessments to determine the appropriate level of care within the facility.
  • Collaborate with other facility medical and psychiatric personnel to ensure appropriate recommendations and admissions.
  • Facilitate admissions process for incoming patients including assessment, consent, and inventory of patient belongings.
  • Perform insurance benefit verifications and secure initial pre-authorization for treatment and admission.
  • Monitor patient status throughout the admissions process in accordance with facility policy and/or physician orders.
  • Utilize multiple web-based programs to track and review referrals.
  • Communicate projected admissions to designated internal representatives promptly.
  • Ensure all clinical information from referral sources or patients (including medical comorbidity information) is received, when possible, prior to patient admission.
  • Schedule (when applicable) and complete pre-admission assessments, consult with the admitting physician and communicate disposition recommendations to the patient or their family.
  • Possess skill in preparing and maintaining appropriate medical record documentation that will result in authorization at the level of care being requested of the payor.
  • Complete initial pre-authorization for treatment and admission prior to admission, when possible, and within payor timeframe guidelines.
  • Admit the patient to the registration and accounting system. Complete all admission and consent forms with the patient.
  • Demonstrate a positive, empathetic, and professional attitude toward customers always. When patient needs are not met, acknowledge and work to resolve complaints. Recognize that patient safety is a top priority.
  • When a patient's needs are not met, acknowledge and work to resolve complaints. Recognize that patient safety is a top priority.
  • Coordinate care for patients who are not being admitted and ensure that they receive appropriate follow-up care and referrals.
  • Demonstrate a sense of urgency related to the importance of patient safety and provide excellent customer service.
  • Responsible for conducting safety checks and ensuring that supervision is conducted at 15-minute intervals, as noted in special precautions, or in accordance with individualized supervision guidelines as needed.

OTHER FUNCTIONS:

  • Perform other functions and tasks as assigned.
Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:ย 

  • Minimum of Associate's degree in Nursing.ย ย 
  • Minimum one year of experience working with individuals in a clinical or observational capacity, preferably within the area of specialty for the hiring facility.ย 

LICENSES/DESIGNATIONS/CERTIFICATIONS:ย 

  • Clear and active nursing license in the state.ย 
  • CPR and de-escalation/restraint certification required (training available upon hire and offered by facility).ย 
  • First aid may be required based on state or facilityย 

We are committed toย providingย equalย ย employmentย opportunitiesย toย all applicantsย forย employmentย regardlessย ofย anย individual'sย characteristicsย protected byย applicable state,ย federalย andย localย laws.

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Employment Type: FULL_TIME