Utilization Review Nurse Certification and Training Program Info

Utilization review nurses are registered nurses who review patient cases, ensuring the patient is receiving proper treatment while verifying that health care costs and policies are being followed. Those interested in this career path can start by earning a bachelor's degree in nursing. Through didactic and clinical coursework, bachelor's programs prepare students for registered nurse (RN) licensure. RNs can then pursue certificates in health care risk management or case management.

Essential Information

A bachelor's degree program in nursing teaches students general patient care and administrative duties as they pertain to nursing. Students learn to communicate with patients, physicians, and other health care professionals to make sure patients are receiving the appropriate care. Before practicing nursing in the United States, registered nurses are required to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN), according to the BLS. After becoming an RN, individuals who wish to become a utilization review nurse must complete additional training. Certificate programs in health care risk management or case management introduce those who already work in the field of health care to the basic concepts, techniques, and purpose of health assessment and management. Students learn how to improve quality assessment reporting by defining and describing utilization review plans and understanding how to file and report case management claims. Graduates of these certificate programs may be prepared for board certification as utilization review nurses.

  • Program Levels in Utilization Review Nursing: Bachelor's degrees, Certificate programs
  • Prerequisites: High school diploma (for a bachelor's), must be an RN to qualify for the certificate programs
  • Experiential Learning: Lots of hands-on clinical work

Bachelor's Degree Programs in Nursing

These programs teach students how to identify and assess health problems in patients. Students learn proper ways to communicate with patients and their families during difficult situations while evaluating patient symptoms and appropriately reporting their findings to a physician. They also receive clinical practice in teaching hospitals before graduating to prepare for further training and certification. Other coursework that may be offered can include:

  • Health assessment
  • Adult health
  • Nursing research
  • Pharmacology
  • Illness care

Certificate Programs in Health Care Risk Management

Applicants must be current RNs or health care professionals to enroll in these programs. Students in this program learn about risk assessment, insurance procedures, and quality assurance in order to assure patients receive the best medical care for their needs. Common course topics include:

  • Patient safety
  • Insurance basics
  • Health care ethics
  • Case management
  • Corporate compliance

Employment Outlook and Salary Info

According to the U.S. Bureau of Labor Statistics (BLS), those working as registered nurses earned an average salary of $69,790 as of May 2014. The number of registered nursing jobs is expected to grow about 19%, faster than the national average, for the decade 2012-2022, per the BLS.

PayScale.com reports that, as of July 2015, most utilization review nurses earned between $45,735 and $77,309. Salaries may be higher for those who work in hospitals or health care management systems.

Certification in Utilization Review

Since utilization review holds accountability of patient care, employers may require them to be certified. Organizations such as the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) offer Health Care Quality and Management (HCQM) Board Certification to nurses working in utilization management. Certification is granted once an examination is completed successfully.

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