Becoming a Utilization Nurse
So you think you might like to become a utilization nurse…
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.
So what are the career requirements?
|Degree Level||Minimum of associate's degree is required (many employers prefer a bachelor's degree)|
|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.
Find schools that offer these popular programs
- Clinical Nursing
- Critical Care Nursing
- Direct-Entry Midwifery - LM, CPM
- Licensed Vocational Nurse Training
- Mental Health Nursing
- Neonatal Nursing
- Nurse Anesthetist
- Nurse Assistant or Patient Care Assistant
- Nurse Midwife
- Nurse Practitioner or Family Nurse Practitioner
- Nursing Administration
- Nursing for Adults and Seniors
- Nursing Science
- Occupational Health Nursing
- Operating Room and Surgical Nursing
- Pediatric Nursing
- Public Health Nurse or Community Nurse
- Registered Nurse
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.
- 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.