Utilization review nurses review requests for treatment on patients and review medical records for necessity. This avoids unnecessary treatments and keeps medical costs down. If this sounds like something you would enjoy, then this may be the best nursing career choice for you. Before entering this field, you will need to meet the nurse training requirements first. Online nursing schools are a great option for those who are looking for a way to get started with this fascinating field.
Use these tips to prepare for utilization review nurse jobs:
- Obtain a degree in nursing. Before becoming a utilization review nurse, you’ll first need to obtain your high school diploma. It is important to have courses in science and maintain at least a 2.5 GPA in high school. After graduation, you have a few choices for your nursing education. The first is obtaining your two-year Associate of Science degree. This is the basic degree needed to become a Registered Nurse. The more preferable degree by employers is a four-year Bachelor of Science degree. This is a requirement for most advanced nursing positions and will increase your wages and employability. There are several “fast-track” nursing programs that enable those with an Associate Degree to elevate their credentials to a full bachelor’s degree. Usually, this is done by nurses in order to further open up their nursing job opportunities for promotion and specialization.
- Take the licensure exam. In the United States, graduates of nursing will need to take the National Council Licensing Exam for Registered Nurses (NCLEX-RN) before starting a nurse career. Upon obtaining a passing score, they will be qualified to work registered nursing jobs.
- Obtain experience as a nurse. It is highly important that individuals get experience working as a registered nurse before they can be equipped to work in the utilization review nursing field; in fact, many of these type of nurses have been registered nurses for 5 to 20 years. This is because they have to be familiar with the hospital treatments and procedures as well as insurance policies in order to make the best decisions.
- Get certified. You can obtain utilization review nurse certification from national certifying bodies. One association is the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP). This board requires that you have a current nursing license, show that you have been involved in quality management for the five years prior to your application, 208 hours or two hours per week in a related field, and two professional references. You will need to have at least 20 hours of your continuing education in quality management and a good working knowledge of the English language. You will apply for your certification and select a proctor that will administer your exam. The test consists of multiple choice questions and the board provides study guides for the exam. If you pass, you will receive certification as a utilization review nurse.
Job Responsibilities
Utilization review nurses specialize in reviewing patient’s medical records and assists with decisions on the necessity of procedures. They take into consideration the condition of the patient, the mode of treatment offered by his physician, the costs of the treatment (including the insurance policy of the patient) and the best treatment options within these considerations.
If you decide on this field of nursing, you will find yourself needing to make critical decisions that will largely determine the patient’s well-being. You will need to be seasoned in the healthcare profession, so you will know different treatment options that will best fit the particular situation of patients. At the same time, you should be well-versed in hospital procedures and policies, costs and insurance provisions. There are times when utilization review nurses may feel that the patient’s treatment is in danger of being compromised just because their insurance policy doesn’t make them eligible for certain treatments; however, they should have the professionalism to make straightforward decisions that will fit the situation they are faced with.
In order to succeed in this type of nursing, you should be highly analytical, should be able to work with data and make critical decisions regarding these data, have strong decision-making skills, and should be able to work well even under pressure. Due to the nature of the position, you will need to have a high degree of professionalism and excellent communication skills to become a utilization review nurse.
Wages and Job Opportunities
Utilization review nurses, according to data by the U.S. Bureau of Labor Statistics, hold one of the highest salary means in the nursing profession, the average annual salary is about $74,000. Not only is the salary quite good, becoming part of this profession will also give you the chance to positively make an impact in other people’s lives.
Job opportunities include working for insurance companies, surgery centers, hospitals and long-term care facilities. There are also many exciting travel nurse positions open for this type of nurse and some agencies will pay for your relocation.
Remember, the important thing here is to obtain the necessary healthcare experience to help you gain confidence and to equip you with making the best possible decisions for your patients.