Utilization Management Certification and Certificate Program Info

Learn about certificate programs that emphasize utilization management, such as medical case management programs. See coursework topics and popular career options for utilization management professionals.

Essential Information

Healthcare facilities often undergo a utilization management assessment, whereby they are evaluated for the efficiency of their healthcare services and procedures. A medical case management certificate program can prepare individuals to begin careers in health utilization management. Medical case management certificate programs are commonly offered through the continuing education or professional development departments of 4-year universities. They are typically designed for currently licensed healthcare professionals who are looking to make a career change to the administrative side of the industry and become healthcare managers or quality management specialists.

Such programs strive to provide students with a basic understanding of the rules and regulations governing the utilization management process. Students gain the educational background and practical skills necessary to examine healthcare facilities on a case-by-case basis and determine if patient needs are always given priority over the pressure to reduce costs. Such programs can often be completed in one year or less. Professional organizations grant related certification credentials to candidates who fulfill experience and educational requirements and pass skills examinations.

Education Prerequisites

Medical case management certificate programs are open to physicians, registered nurses, licensed vocational nurses, nurse practitioners, substance abuse counselors and other medical professionals. Each of these individuals is required to earn some type of degree and licensure before they can begin practice in their field.

Program Coursework

The courses included within a medical case management certificate program cover both the theories of utilization management, as well as the practical, day-to-day duties of healthcare case managers. Some specific course topics include:

  • Effective case management
  • Connecting to healthcare systems
  • Life care planning
  • Utilization review
  • Quality management in healthcare facilities
  • Medicine and ethics
  • Medical case management in the field

Popular Career Options

Completing a certificate program in medical case management prepares healthcare professionals for several potential career options in the field of utilization management. Some of these include:

  • Utilization management director
  • Medical case manager
  • Healthcare manager
  • Registered nurse, utilization review
  • Quality management specialist

Employment Outlook and Salary Information

Over the 2010-2020 decade, the U.S. Bureau of Labor Statistics (BLS) expects job growth to be 34% for healthcare social workers (includes medical case managers), 26% for registered nurses and 22% for medical and health services managers ( reported the median annual salaries for various utilization management careers in December 2013. Utilization management registered nurses earned a median wage of $65,714, and utilization management nurse reviewers earned a median wage of $60,020. The same source reported that utilization management case managers earned a median wage of $63,784 and that utilization management supervisors earned a median wage of $69,255.

Certification Options

A few different organizations offer certification for professionals working in the field of healthcare utilization management. These include the National Committee for Quality Assurance and the American Board of Quality Assurance and Utilization Review Physicians. These organizations accredit individuals or organizations offering healthcare utilization management services.

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