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Clinical Utilization Manager

1 month ago

Newark, Delaware, United States ChristianaCare Full time
Job Title: Clinical Utilization Manager

Christiana Care is seeking a skilled Clinical Utilization Manager to join our team. As a key member of our Utilization Management team, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.

Job Summary:

The Clinical Utilization Manager will be responsible for reviewing medical necessity and collaborating with healthcare providers to ensure the most appropriate level of care for patients. This role requires strong clinical knowledge, excellent communication skills, and the ability to work collaboratively with a multidisciplinary team.

Key Responsibilities:
  • Conduct thorough reviews of patient records to determine medical necessity and appropriateness of care
  • Collaborate with healthcare providers to develop and implement individualized care plans
  • Monitor and report on utilization trends and identify opportunities for improvement
  • Participate in performance improvement initiatives to enhance patient outcomes and reduce costs
  • Provide education and support to nursing and ancillary staff on utilization review processes
Requirements:
  • Active DE RN licensure or compact state RN licensure
  • Bachelor's degree in nursing
  • Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting
  • Clinical documentation, performance improvement, case management, or utilization management experience desirable
What We Offer:
  • Competitive salary and benefits package
  • Opportunities for professional growth and development
  • Collaborative and supportive work environment
About Us:

Christiana Care is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. We offer a comprehensive benefits package, including medical, dental, vision, life insurance, tuition assistance, and more.