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How to Become a Utilization Nurse

Research the requirements to become a utilization nurse. Learn about the job description and duties, and read the step-by-step process to start a career as a utilization nurse. View article »

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  • 0:04 Becoming a Utilization Nurse
  • 0:41 Career Requirements
  • 1:37 Step 1: Earn a Nursing Degree
  • 2:09 Step 2: Get Licensed
  • 2:35 Step 3: Get Clinical…
  • 2:57 Step 4: Get Case…

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Video Transcript

Becoming a Utilization Nurse

So you think you might like to become a utilization nurseā€¦

Utilization nurses, also known as utilization review nurses, are licensed nurses who are responsible for making decisions about the type of care provided to patients based on medical necessity and insurance coverage. They report to insurance companies, hospitals, and doctors and decide which emergency procedures to approve and when to discharge a patient. This is a position for experienced nurses who can make difficult decisions and deal with the related stress and responsibility.

Career Requirements

So what are the career requirements?

Degree Level Minimum of associate's degree is required (many employers prefer a bachelor's degree)
Degree Field Nursing
Licensure and Certification RN licensure is preferred; some employers accept those with a LPN license; voluntary certification is available
Experience 2-5 years of experience as an RN; some experience in case management or utilization review
Key Skills Communication (written and oral) skills, organizational skills, problem solving skills; knowledge of Microsoft Office software and case management software (such as InterQual); possession of current American Heart Association's Basic Life Support Health Care Provider card preferred by some employers
Median Salary (2015*) $66,640 (for registered nurses)

Sources: *U.S. Bureau of Labor Statistics, O*NET OnLine

Step 1: Earn a Nursing Degree

While some employers may hire utilization nurses with an associate's degree, employers may prefer those who have a Bachelor of Science in Nursing (BSN). Students in a bachelor's degree program in nursing typically take general courses in the sciences, as well as take classes in anatomy, physiology, nutrition, patient care, and psychology. They also get clinical experience under supervision in areas including maternity, surgery, and pediatrics.

Step 2: Get Licensed

Nursing students seeking licensure must pass the National Council Licensure Examination for either registered nurse or practical nurse, which is offered by the National Council of State Boards of Nursing. This exam tests candidates on the nursing process, patient care, communication techniques for nurse-patient interactions, and documentation of medical information.

Step 3: Get Clinical Experience

Job ads show that employers prefer utilization nurses who have had around 2-5 years of clinical experience. This allows nurses to gain skills in patient care, as well as increase their familiarity with medical terminology, hospital equipment, and patient needs.

Step 4: Get Case Management or Utilization Review Experience

Employers often require potential utilization nurses to have experience in case management or knowledge of utilization review. This experience could come from assisting current utilization nurses or completing a case management training program offered through a college or hospital. These programs often include coursework on utilization review and case management software programs, such as InterQual.

Success Tip:

  • Become a Certified Case Manager. Though not required for this position, certification may help you stand out in this field. The Certified Case Manager (CCM) credential is offered by the Commission for Case Manager Certification. To qualify for this credential, qualified registered nurses must prove their moral character by answering a questionnaire about their criminal and professional history. They must have at least one year's experience working under a CCM-certified professional or two years of independent case management experience. Qualified nurses also have to take an exam that tests them in areas such as healthcare reimbursement, principles of practice, and case management concepts.

Earn a nursing degree, get licensed, gain clinical experience, and obtain case management or utilization review experience are the steps to follow to make the most of a career as a utilization nurse.


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