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Utilization review nurses review patient records to make decisions about care, requiring a nursing degree, license, and experience. Continuing education is necessary, and a clean record is important for positions that require background checks. Specialist experience can lead to better job opportunities and negotiation power.
To become a utilization review nurse, it is usually necessary to have a nursing degree, a valid nursing license, and experience in the field. These nursing professionals review patient records to make decisions about what types of care to approve or recommend. They work for hospitals and insurance companies as part of managed care programs to provide the most efficient, appropriate, and effective care for patients. It can take four years or more to become a utilization review nurse, and the job requires continuing education to keep up with trends in treatments and managed care.
The first step for a person who wants to become a utilization review nurse is to receive a nursing education and successfully pass the tests required for licensure. Registered nurses can work in this field, as can people with graduate degrees in nursing or public health. After passing the test to obtain a nursing license, you may also need to keep up with continuing education requirements to maintain the license.
With a license, it is possible to enter clinical practice. Experience is critical for utilization review nurses, and it is generally necessary to have worked in the field for at least one year to become a utilization review nurse. Skilled nursing experience can be particularly helpful; a nurse who focuses on oncology, for example, has the knowledge and experience needed to accurately review cancer patient records. Utilization review nurses come from backgrounds ranging from military nursing to midwifery and may be familiar with needs related to specific patient populations.
Some utilization review nursing positions require taking the civil service exam and passing a background check, depending on the employer. A person who wants to become a utilization review nurse must keep a clean personal and professional record in case a background check is required. This position involves working with confidential and sometimes restricted material, and therefore employers want to be careful who they hire for usage review positions. It can help to have a strong employment history, with glowing letters of recommendation.
With training, certification, and experience, a nurse can begin applying for utilization review positions. Someone planning to become a utilization review nurse may want to relocate, as this can open up more job opportunities. Also, the more experience nurses have, especially specialist experience, the better they stand when it comes to negotiating salaries and benefits.
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