Utilization Management Nursing

Learn How to Become a Utilization Management Nurse

Utilization management nurses work behind the scenes to maximize the quality and cost efficiency of health care services. Through regular reviews and audits, they ensure that patients receive the care they need without burdening the health care 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 BSN
  • Become an RN
  • Get Utilization Management or Case Management certification and Basic Life Support certification

Annual Salary Range
$66,500 – 85,000


 Typical Tasks

  • Advising insurance companies and health care facilities on questions of hospital admission, length of stay, surgeries, medications, referrals and many procedures
  • Reviewing medical records
  • Talking to patients and providers
  • Concurrent review of patient’s clinical information for efficiency
  • Ongoing review of precertification requests for medical necessity
  • Monitor the activities of clinical and non-clinical staff
  • Coordinates patient’s discharge planning needs with the health care team

Employment Settings

  • Hospitals
  • Nursing homes
  • Clinical settings

Certification

RN


Education Requirements

BSN


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