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Utilization Reviewer Jobs in Delaware (NOW HIRING)

Encore at Wilmington

Director of Admissions

Wilmington, DE · On-site

$75K - $85K/yr

Support utilization review processes for Medicare admissions * Maintain strict confidentiality of all resident information Qualifications: * Experience in long-term care, skilled nursing, or health ...

Dane Street

Otolaryngology Physician

Dover, DE

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 ...

Acadia Healthcare

RN Admissions Part Time

New Castle, DE · On-site

$39.53 - $43.66/hr

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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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 16, 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
Registered Nurse (RN) - Patient Care Coordinator

Registered Nurse (RN) - Patient Care Coordinator

TidalHealth

Seaford, DE • On-site

$75K - $121K/yr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

TidalHealth rating

6.3

Company rating: 6.3 out of 10

Based on 59 frontline employees who took The Breakroom Quiz

665th of 872 rated healthcare providers

Job description

Why work at TidalHealth?
Looking for a rewarding place to work? Choose TidalHealth. Our hospitals have been named among the Top 5 percent of all U.S. hospitals by Healthgrades and a five-star hospital by the Centers for Medicare & Medicaid Services. Located just 30 minutes from the beach, TidalHealth offers the widest array of specialty and subspecialty services such as neurosurgery, cardiothoracic surgery, joint replacement, emergency/trauma care, comprehensive cancer care, wound care and clinical trials and research. Take advantage of our tuition and certification assistance programs to grow both personally and professionally.
RN - Patient Care Coordinator Position Summary
The primary function of the RN - Patient Care Coordinator is to coordinate the patient's care across all departments, disciplines and providers. They ensure appropriate continued stay utilization while providing appropriate and safe discharge planning. The RN - Patient Care Coordinator also functions as patient advocates and liaisons to regulatory agencies, insurance companies, and various state agencies. This team provides support to Medical, Surgical, Critical Care, and Women's and Children areas 7 days a week.
RN - Patient Care Coordinator Position Requirements
  • Licensed and currently registered to practice as a Registered Nurse. Must hold a license in the state of permanent residency.
  • American Heart Association Basic Life Support (BLS)
  • Minimum of 3 to 5 years' experience in an acute care hospital.
  • Home health, case management experience with an insurance carrier or HMO and/or Utilization Review and discharge planning experience preferred.
  • Case Management certification preferred

RN - Patient Care Coordinator Work Schedule
  • Day shift Monday-Friday, Evening and weekend work as assigned.

RN - Patient Care Coordinator Benefits
  • At TidalHealth, full-time employees working at least 72 hours per pay period, part-time employees working at least 36 hours per pay period and part-time employees working at least 30 hours or more on weekends only are eligible for benefits.
  • Benefits include medical, prescription, vision, dental, flexible spending accounts, disability insurance plans, life insurance, paid time off plans, retirement plans, tuition assistance, employee assistance, and access to on-site childcare and a credit union.

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