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How Do I Become a Utilization Review Nurse?

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  • Written By: Mary McMahon
  • Edited By: Nancy Fann-Im
  • Last Modified Date: 20 September 2014
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To become a utilization review nurse it is usually necessary to have a degree in nursing, a valid nursing license, and experience in the field. These nursing professionals review patient records to make decisions about what kinds 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 to patients. It may take four or more years to become a utilization review nurse, and the work 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 required tests 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 get a nursing license, it may also be necessary to keep up with continuing education requirements to maintain the license.

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With a license, it is possible to enter clinical practice. Experience is critical for utilization review nurses, and it is usually necessary to have worked in the field for at least a year to become a utilization review nurse. Specialty nursing experience can be particularly useful; a nurse who focuses on oncology, for example, has the knowledge and experience necessary to accurately review the records of cancer patients. Utilization review nurses come from backgrounds ranging from military nursing to obstetrics, and may be familiar with needs related to specific patient populations.

Some utilization review nursing positions require taking the civil service examination and passing a background check, depending on the employer. A person who wants to become a utilization review nurse should maintain a clean personal and professional record in case a background check is necessary. This position involves working with confidential and sometimes restricted material, and thus employers want to be careful about who they hire for utilization review positions. It can help to have a strong employment record, with glowing letters of recommendation.

With training, certification, and experience, a nurse can start to apply for utilization review positions. Someone who plans to become a utilization review nurse may want to consider relocating, as this could open up more job opportunities. Additionally, the more experience nurses have, especially specialized experience, the better position they will be in when it comes to negotiating salary and benefits.

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