Utilization Management RN – Acute Care Navigator

Christiana Care Health System; Newark (DE); On-site; USD 85,862 - 137,384; Full time

Job summary

ChristianaCare Health System in Newark, DE, is seeking a Utilization Management Nurse (RN) for a full-time on-site day shift at the Newark Hospital to evaluate medical necessity and efficiency of care under the applicable health benefits plan.

The RN will perform admission and concurrent reviews within 24 hours, collaborate with the care team, and coordinate with insurers (Aetna/Cigna) to secure timely authorizations. Strong denial management experience is preferred.

Qualifications

• Bachelor's degree in nursing required.
• Minimum 3 years acute care RN experience.
• Minimum 3 years Utilization Management experience.
• Denial management experience required.
• Experience with insurance providers preferred (Aetna, Cigna).

Responsibilities

• Performs admission and concurrent review to identify medical necessity within 24 hours.
• Collaborates with the care team to ensure a multidisciplinary plan of care.
• Manages observation level of care and ensures stays do not exceed 48 hours.
• Identifies barriers to care and participates in performance improvement efforts.
• Monitors scheduling efficiencies and coordinates diagnostics and treatments.
• Reports LOS data and physician profile information.

Skills

RN licensure eligible (DE or compact)

Bachelor's degree in Nursing

Utilization Management experience

Denial management experience

Insurance carrier experience (Aetna/CI

Education

Bachelor's degree in nursing

DE RN licensure or compact state RN licensure

Job description

ChristianaCare Health System in Newark, DE, is seeking a Utilization Management Nurse (RN) for a full-time on-site day shift at the Newark Hospital to evaluate medical necessity and efficiency of care under the applicable health benefits plan.

The RN will perform admission and concurrent reviews within 24 hours, collaborate with the care team, and coordinate with insurers (Aetna/Cigna) to secure timely authorizations. Strong denial management experience is preferred.