Utilization Management Nursing

How to Become a Utilization Management Nurse

Utilization management nurses work behind the scenes to maximize the quality and cost efficiency of healthcare services. Through regular reviews and audits, they ensure that patients receive the care they need without burdening the healthcare system with unnecessary procedures, ineffective treatments or overlong hospital stays. Utilization management nurses also help insured patients to make informed decisions about their health care by educating them on the benefits and limitations of their Medicare, Medicaid or private health care coverage.

Preparation Path

  • EARN YOUR ASN OR BSN
  • PASS YOUR NCLEX AND BECOME AN RN
  • GET AT LEAST TWO YEARS OF ACUTE CARE EXPERIENCE
  • OBTAIN CERTIFICATION THROUGH THE AMERICAN BOARD OF QUALITY ASSURANCE AND UTILIZATION REVIEW PHYSICIANS (VOLUNTARY)

$44,000 - $90,000

Annual Salary Range

Typical Tasks

  • Advising insurance companies and healthcare facilities on questions of hospital admission, length of stay, surgeries, medications, referrals and many procedures
  • Reviewing medical records
  • Talking to patients and providers

Education Requirements

ASN, BSN (increasingly preferred)

Employment Settings

  • Hospitals
  • Nursing homes
  • Clinical settings

Certification

RN