Top 10 Utilization review nurse Jobs in Delaware

Clinical Claims Review Nurse
CVS Health —Delaware
- $26.01 - $68.55 an hour
- Full-time
- Remote
- Nursing
- RN License
- Customer service
- Health insurance
- Dental insurance
3d
Utilization Management Registered Nurse
Humana —Delaware
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Utilization Management Nurse Consultant
CVS Health —Delaware
- $26.01 - $68.55 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Computer literacy
- Health insurance
- Dental insurance
6d

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Utilization Management Registered Nurse
Humana —Delaware
Must hold Compact Registered Nurse (RN) license in your state of residence. BSN or bachelor's degree in a related field. (i.e. 10 reviews per day?).
$71,100 - $97,800 a year
Utilization Management Nurse Consultant
CVS Health —Delaware
Must have active current and unrestricted RN licensure in state of residence. Work requires sitting for extended periods, talking on the telephone and typing on…
$26.01 - $68.55 an hour
6d

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utilization review nurse jobs near delaware

Clinical Claims Review Nurse

CVS Health -
Delaware

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Job Details

Full-time
$26.01 - $68.55 an hour
3 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

Nursing
Decision making
Nursing
Analytics

Full Job Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This role requires the nurse to exercise clinical judgment and perform the following duties:

Review and interpret clinical documentation obtained from medical records or systems.
Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims
Coordinate clinical resolutions independently, with clinician/MD support as required
Act as a resource for customer service and claims processing teams
Train new staff and provide cross-training to existing team members
Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified
Remain current with applicable laws, regulations, and internal workflows to ensure full compliance with organizational and state-specific requirements

Required Qualifications:

Nursing degree (RN)
A minimum of 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience
Strong analytical skills to assess medical claims

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$26.01 - $68.55

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 07/08/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Apply Now

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utilization review nurse jobs in delaware

Clinical Claims Review Nurse

Utilization Management Registered Nurse

Utilization Management Nurse Consultant

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