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Utilization Review Jobs in Delaware (NOW HIRING)

Evolent

Radiation Oncology Field Medical Director

Dover, DE · On-site

$130 - $145/hr

  • Medical

Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...

Bayhealth

Licensed Masters Social Worker (LMSW)

Dover, DE · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... Utilization Review process. 5. Accurately and completely records all required data and information in the medical record and related record keeping systems. 6. Recognizes urgent utilization and ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Conducts initial medical necessity review of exception preauthorization requests for services ... Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Conducts initial medical necessity review of exception preauthorization requests for services ... Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health ...

Delaware Caregivers

Director

Dover, DE · On-site

Implement all utilization review activities, including coordination and timely implementation of corrective action plans and controls. JOB CONDITIONS * Position is stressful in terms of meeting ...

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Conducts initial medical necessity review of exception preauthorization requests for services ... Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health ...

SUN Behavioral Delaware

Intake Coordinator I

Georgetown, DE · On-site

$16.50 - $22.75/hr

Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the ...

SUN Behavioral Delaware

Intake Coordinator I

Georgetown, DE · On-site

$16.50 - $22.75/hr

Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the ...

SUN Behavioral Delaware

Intake Coordinator I

Georgetown, DE · On-site

$16.50 - $22.75/hr

Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the ...

SUN Behavioral Delaware

Intake Coordinator I

Georgetown, DE · On-site

$16.50 - $22.75/hr

Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the ...

Acadia Healthcare

RN Admissions Part Time

New Castle, DE · On-site

$39.53 - $43.66/hr

  • Medical

  • Dental

  • Vision

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 ...

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Showing results 41-60

All JobsUtilization Review JobsUtilization Review Jobs in Delaware

Utilization Review information

See Delaware salary details

$21

$42

$69

How much do utilization review jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for utilization review 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.

Is utilization review work from home?

Utilization review jobs can often be performed remotely, especially with the increased adoption of telecommuting in healthcare and insurance industries. Many employers offer work-from-home options, provided the reviewer has the necessary certifications and access to electronic health records or claims systems. However, some positions may require on-site presence for meetings or audits.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, which can be stressful due to strict deadlines, high accuracy requirements, and the need to balance patient care with insurance policies. The job often requires strong attention to detail, communication skills, and the ability to handle complex cases under time pressure.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, such as the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects. Relevant skills include knowledge of medical coding, insurance policies, and strong analytical abilities.

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 jobs in Delaware?

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

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

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

What cities in Delaware are hiring for Utilization Review jobs?

Cities in Delaware with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Delaware as of August 2026, with employment types broken down into 84% Full Time, 8% Part Time, and 8% Contract. Highlights an 92% In-person, and 8% Remote job distribution, with an average salary of $88,022 per year, or $42.3 per hour.

Physician Otolaryngology - Competitive Salary

Dane Street

Dover, DE

Other

Re-posted 18 days ago

Job description

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care.

MAJOR DUTIES AND RESPONSIBILITIES:

    • Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria
    • Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision
    • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes
    • Provides copies of any criteria utilized in a review with the report in a timely manner
    • Returns cases on or before the due date and time
    • Makes telephone calls as mandated by the state and/or client specifics
    • Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
    • Attends all required orientation and training
    • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits
  • Board certification required, active practice required

PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment. 

Benefits

  • Robust opportunity for supplemental income
  • Schedule flexibility and predictable work hours - You choose services and case types, dictate volume, and conduct exams and reviews based on your schedule availability
  • No doctor/patient relationship is established and no treatment is provided. These are advisory-only opinions.
  • Enhanced industry expertise strengthening your medical practice with medical necessity and utilization review/management expertise
  • Expanded credentials as an expert in Independent Medical Exams and physician advisor services
  • Fully prepped cases, streamlined case flow, transcription services at no cost, and user-friendly work portal

Dane Street supports all referral processes, scheduling, preps cases extensively, prepares all medical records, provides transcription services as applicable, facilitates all client communications, and ensures the quality and timeliness of all reports and report delivery.  

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