Utilization Review Nurse Certification and Training Program Info
Utilization review nurses are registered nurses who review patient cases, insuring the patient is receiving proper treatment while verifying that health care costs and policies are being followed. Students looking to work as utilization review nurses need a nursing degree and nursing certification, as well as training in utilization review management.
Bachelor of Science in Nursing
A bachelor's degree program in nursing teaches students general patient care and administrative duties as they pertain to nursing. Students learn to communicate with patients, physicians, and other health care professionals to make sure patients are receiving the appropriate care. Students often need to have a high school diploma before being admitted into a nursing program.
Nursing programs at the bachelor's level 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. Nursing students 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
Employment Outlook and Salary Info
According to the U.S. Bureau of Labor Statistics (BLS), those working as registered nurses earned an average salary of $67,930 as of May 2012. The number of registered nursing jobs is expected to grow about 26%, faster than the national average, for the decade 2010-2020, per the BLS.
Certification for Registered Nurses
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. Those interested in becoming registered nurses must complete an approved nursing program before taking the test and applying for licensure.
Health Care Risk Management Certificate
After becoming a registered nurse, 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. Individual courses in utilization review are also available. 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
PayScale.com reports that, as of October 2013, most utilization review nurses earned between $44,378 and $73,291. 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.
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