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Utilization Reviewer Jobs in Delaware (NOW HIRING)

Encompass Health Rehabilitation Hospital of Middletown

$34.61 - $62/hr

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 ...

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 ...

Acadia Healthcare

RN Admissions

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 ...

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 ...

Acadia Healthcare

RN Admissions

New Castle, DE

$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 ...

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 Sep 10, 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 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.

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 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 do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
More about Utilization Reviewer jobs

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

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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:

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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 September 2026, with employment types broken down into 84% Full Time, 11% Part Time, and 5% Contract. Highlights an 95% In-person, and 5% Remote job distribution, with an average salary of $38,025 per year, or $18.3 per hour.

Certified Case Manager

On-site

Encompass Health Rehabilitation Hospital of Middletown
Hospitals • 10K+ employees
Learn more about Encompass Health Rehabilitation Hospital of Middletownexternal

$34.61 - $62/hr

Other

Posted 12 days ago

Encompass Health rating

7.0

Company rating: 7.0 out of 10

Based on 423 frontline employees who took The Breakroom Quiz

Job description

The Certified Case Manager (CCM) serves as a key member of the interdisciplinary team and actively manages and directs resource utilization to achieve the highest quality outcomes during a patient's rehabilitation experience. The CCM coordinates and advocates for the patient during their hospitalization and from admission to post discharge. As an effective communicator, the CCM manages information to effectively oversee health care delivery and facilitate interdisciplinary plan of care decisions. The CCM facilitates timely communication regarding the patient's care, establishes and monitors the discharge plan implementation while identifying and addressing patient's psychosocial and support systems issues. The CCM oversees the effective coordination of services and manages issues in the following main areas: admission and discharge, team conference and interdisciplinary plan of care communication, patient and family education, payor relations and total fiscal management. 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's rights are fulfilled.

The Encompass Health Way
We proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!
At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.

What Encompass Health employees say

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Benefits

Hours and flexibility

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About Encompass Health

Sourced by ZipRecruiter

Helping patients regain hope and independence, Encompass Health is a national leader in post-acute care. We operate rehabilitation hospitals in 36 states as well as Puerto Rico. Following the Encompass Way, we are driven by our core values: We proudly set the standard, lead with empathy, do what's right, focus on the positive, and remain stronger together.

Industry

Hospitals and outpatient health care

Company size

10,000+ Employees

Headquarters location

Birmingham, AL, US

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