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.
A bachelor's degree program in nursing teaches students general patient care and administrative duties as they pertain to nursing. 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.
Both of these programs involve a lot of hands-on clinical work. Students applying to a certificate program must have a bachelor's degrees and be a qualified RN. Prior to enrollment in a bachelor's degree program, students need to have a high school diploma.
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
- 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 a median salary of $71,730 as of May 2018. The number of registered nursing jobs is expected to grow about 12%, faster than the national average, for the decade 2018-2028, per the BLS.
PayScale.com reports that, as of September 2019, most utilization review nurses earned between $53,000 and $84,000. 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.
The first step to becoming a utilization review nurse is to earn a bachelor's degree in nursing and then pursuing licensure to become an RN. RNs may then pursue a certificate program in health care risk management to become a utilization review nurse.