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Utilization Reviewer Jobs in Delaware (NOW HIRING)

Humana

Compliance UM Nurse (Wed - Sun)

Dover, DE · On-site

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

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 ...

Evolent

Field Medical Director, Vascular Surgeon

Dover, DE · On-site

$130 - $140/hr

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 ...

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Showing results 21-40

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 Aug 12, 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 is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

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 are the key skills and qualifications needed to thrive as a utilization reviewer?

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
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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 August 2026, with employment types broken down into 40% Full Time, 40% Part Time, and 20% Contract. Highlights an 80% In-person, and 20% Remote job distribution, with an average salary of $38,025 per year, or $18.3 per hour.

Remote Clinical Review Pharmacist

Pharmacy Careers

Wilmington, DE • On-site

$115K - $137K/yr

Other

This job post has expired today. Applications are no longer accepted.

Job description

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule
Leverage your clinical knowledge in a fully remote Clinical Review Pharmacist role. Evaluate prescriptions and treatment plans for safety, appropriateness, and cost-effectiveness while working from home.
Key Responsibilities

  • Review prescriptions, treatment plans, and clinical requests for appropriateness, safety, and value.
  • Apply clinical guidelines and evidence-based standards to support determinations.
  • Collaborate with physicians, nurses, and utilization-management teams on complex cases.
  • Document recommendations and decisions according to health-plan and regulatory requirements.
  • Participate in quality initiatives and peer-to-peer discussions as needed.
What You'll Bring
  • Education: PharmD or Bachelor of Pharmacy.
  • Licensure: Active, unrestricted U.S. pharmacist license.
  • Experience: Clinical review, utilization management, or managed care preferred. Hospital, ambulatory, and community pharmacists with strong clinical judgment are highly encouraged to apply.
  • Skills: Excellent clinical writing, critical thinking, and communication.
Why This Role?
  • 100% remote with flexible scheduling.
  • Help patients access safe, effective, and affordable medications.
  • Develop specialized expertise in managed care and utilization review.
  • Competitive compensation, full benefits, and advancement opportunities.

About Us
We are a confidential healthcare organization providing managed-care and pharmacy review services across the U.S. Our pharmacists ensure the right medication reaches the right patient at the right time.
Apply Today
Take the next step as a Remote Clinical Review Pharmacist - apply today and enjoy the flexibility of working from home

Apply