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Utilization Reviewer Jobs in Delaware (NOW HIRING)

UHS

Lead UR Coordinator

Dover, DE · On-site

Perform internal utilization reviews as indicated. * Identify, document, and report any and all instances of adult or child abuse and neglect to the appropriate parties including a member of ...

UHS

Lead UR Coordinator

Dover, DE · On-site

Maintain and update logs of review and maintain other appropriate records of the Utilization Review department. * Communicate pertinent third party payors issues to doctor and treatment team.

Christiana Care Health Services

Communication from Talent Acquisition Team about specific next steps, including: video interview and clinical references Applications to be sent for review by residency coordinators Offers to be made ...

Encompass Health

Certified Case Manager

Middletown, DE · On-site

The CCM performs ongoing utilization review and acts as a liaison to the payor while assuring that cost effective treatment is provided by the team. The CCM assures that regulations regarding patient ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Delaware

Utilization Reviewer information

See Delaware salary details

$31K

$38K

$44K

How much do utilization reviewer jobs pay per year?

As of Jun 28, 2026, the average yearly pay for utilization reviewer in Delaware is $38,025.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,000.00 and $42,000.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a Utilization Reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A utilization reviewer evaluates medical records and treatment plans to determine the necessity and appropriateness of healthcare services. They ensure that services comply with insurance policies and industry standards, often using healthcare management software and adhering to regulatory guidelines. This role supports cost containment and quality assurance in healthcare organizations.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in healthcare or insurance, strong analytical skills, and familiarity with medical coding and documentation are important; some roles may require certification such as the Certified Professional Utilization Review (CPUR).

What jobs pay 2000 a day?

Utilization reviewers typically do not earn $2000 a day; such high daily earnings are more common in specialized roles like senior surgeons, high-level consultants, or certain executive positions. These roles often require advanced certifications, extensive experience, and work in high-paying industries such as healthcare, finance, or law. Most utilization review positions offer salaries that are significantly lower than this daily rate.

What Does a Utilization Reviewer Do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What job makes $10,000 a month without a degree?

A utilization reviewer typically earns between $4,000 and $8,000 per month, depending on experience and location, and usually requires relevant healthcare or insurance knowledge. Jobs that can pay $10,000 a month without a degree include high-level sales, real estate brokers, or certain skilled trades like commercial pilots or specialized technicians, often requiring certifications or extensive experience. These roles often involve self-employment, commissions, or high-demand skills that compensate well without formal college degrees.

What are the key skills and qualifications needed to thrive as a Utilization Reviewer, and why are they important?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Delaware? For Utilization Reviewer jobs in Delaware, the most frequently searched job titles are:
What job categories do people searching Utilization Reviewer jobs in Delaware look for? The top searched job categories for Utilization Reviewer jobs in Delaware are:
What cities in Delaware are hiring for Utilization Reviewer jobs? Cities in Delaware with the most Utilization Reviewer job openings:
What are popular job titles related to Utilization Reviewer jobs in DE? For Utilization Reviewer jobs in DE, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Delaware as of June 2026, with employment types broken down into 100% Full Time. Highlights an 93% In-person, and 7% Remote job distribution, with an average salary of $38,025 per year, or $18.3 per hour.
Utilization Management Specialist I - Full-Time

Utilization Management Specialist I - Full-Time

SUN Behavioral Delaware

Georgetown, DE • On-site

Full-time

Posted 13 days ago

Key responsibilities

  • Coordinates case management strategies and care for patients from pre-hospitalization through discharge.

  • Assists with authorization of hospital admissions, processes retroactive reviews and appeals, and communicates with insurance companies to ensure coverage.

  • Documents and updates patient status, denial logs, and care transitions, and participates in daily meetings and performance improvement activities.

Sun Behavioral Health rating

5.3

Company rating: 5.3 out of 10

Based on 9 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

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