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Utilization Review Nurse Certification and Training Program Info

Read about certification and training program information for the utilization review nurse. This article includes program coursework, employment outlook projections and salary statistics.

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Essential Information

Utilization review nurses are registered nurses who review patient cases, ensuring 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 can start by earning a bachelor's degree in nursing. Through didactic and clinical coursework, bachelor's programs prepare students for registered nurse (RN) licensure. RNs can then pursue post-baccalaureate certificates in health care risk management or case management. Graduates of these certificate programs may be prepared for board certification as utilization review nurses.


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.

Program Coursework

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
  • Pharmacology
  • 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.

Program Coursework

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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