A bachelor’s degree in nursing, a valid nursing license, and experience in the field are usually required to work as a utilization review nurse. These nurses examine patient records before deciding what types of treatment to approve or recommend. They work for hospitals and insurance companies to provide the most efficient, appropriate, and effective care to patients as part of managed care programs. To become a utilization review nurse, it may take four or more years of training, and the job requires ongoing education to keep up with changes in treatments and managed care.
A person who wants to work as a utilization review nurse must first obtain a nursing education and pass the required licensure exams. People with graduate degrees in nursing or public health, as well as registered nurses, can work in this field. After passing the test to obtain a nursing license, it may be necessary to meet continuing education requirements in order to keep the license current.
It is possible to enter clinical practice after obtaining a license. To become a utilization review nurse, you must have at least one year of experience in the field. Specialty nursing experience can be especially beneficial; for example, an oncology nurse has the knowledge and experience needed to accurately review the records of cancer patients. Nurses who work in utilization review come from a variety of backgrounds, including military nursing and obstetrics, and may be familiar with the needs of specific patient populations.
Depending on the employer, some utilization review nursing positions require passing the civil service exam and passing a background check. If a background check is required, a person who wants to become a utilization review nurse should keep a clean personal and professional record. Employers should be cautious about who they hire for utilization review positions because they will be working with confidential and sometimes restricted information. Having a solid work history and glowing letters of recommendation can help.
A nurse can begin applying for utilization review positions after obtaining the necessary training, certification, and experience. Relocating might be a good idea for someone who wants to work as a utilization review nurse because it will open up more job opportunities. Furthermore, the more experience nurses have, particularly specialized experience, the better position they will be in when negotiating pay and benefits.