What Is a Utilization Management Nurse?
Written by:
University of Tulsa
• Sep 9, 2024
Health care organizations are constantly juggling many different priorities, goals, and limitations. Providing excellent patient care is always at the forefront, but to do this, health care organizations must ensure that they use their resources as wisely as possible.
The role of the utilization management nurse is to balance these different goals, ensuring that patients get the care they need while also imposing reasonable controls on costs and resource expenditure. This can be a rewarding and important role for nurses who’ve obtained the right level of education and the appropriate type of clinical experience.
What Does a Utilization Management Nurse Do?
A utilization management nurse is a registered nurse (RN) whose job is to ensure that patients get any needed treatments while staying within budgetary and resource parameters. More specifically, these professionals help ensure that patients don’t receive any redundant or unnecessary treatments.
This can not only facilitate a more expedient and affordable experience for the patient but also ensure that the organization itself is using resources judiciously, making it better equipped to provide for all patients’ needs. In this way, utilization management professionals can be significant voices in advocating for health care justice .
Utilization Management Nurse Job Description
While the exact duties associated with this role can vary from position to position, a utilization nurse’s typical job description may look like this:
- Reviewing medical records to confirm treatment appropriateness timeliness, and effectiveness
- Evaluating treatment plans and establishing clear guidelines for the medical and nursing process
- Coordinating care with other health care professionals, patients, or case managers
- Managing and improving sourcing, acquiring, and distribution of institutional resources, including seeking areas to control costs or to work more efficiently
Work Environments for Utilization Management Nurses
Nurses specializing in utilization management may work in various environments. While some find employment in clinical settings, including hospitals and other health care facilities, others work for health insurance companies, ensuring appropriate financial reimbursement and advocating for patient needs.
How to Become a Utilization Management Nurse
To become a utilization management nurse, cultivating the right skills is important. This involves a combination of formal instruction and hands-on experience.
1. Earn a Degree
First and foremost, developing a strong nursing foundation by completing an undergraduate degree program is important. This is usually a Bachelor of Science in Nursing (BSN), although in some cases, an Associate Degree in Nursing (ADN) may work.
2. Obtain a Nursing License
Upon completion of a degree program, the next step is to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). State nursing boards administer the NCLEX-RN, which allows prospective nurses to earn their licensure.
Even though it’s possible to get an RN license with an ADN degree, there are differences between holding an RN license and a BSN degree , and nurses without a BSN may want to consider earning their RN to BSN . Most employers prefer nurses with BSNs, according to the American Association of Colleges of Nursing (AACN). BSNs are also usually required to enter graduate nursing programs, such as a Master of Science in Nursing (MSN), which can lead to career advancement.
3. Seek Experience
Obtaining work as a full-time utilization management nurse usually requires a couple of years of experience in clinical care. Ideally, this experience would be in a health care facility’s utilization or case management department.
4. Foster Essential Skills
Through this combination of education and experience, RNs can cultivate the skills that are most necessary for success in the utilization management role. The most important competencies include analytic thinking, attention to detail, patient advocacy, financial acumen, and familiarity with regulatory compliance issues.
Salary and Job Outlook for a Utilization Management Nurse
Those who are drawn to this field will naturally have some questions about the salary potential as well as the overall career outlook.
Salary Range
According to Payscale data from July 2024, the median annual salary for this position is about $77,770. Several factors can affect this pay rate, including years of experience and level of education.
Job Outlook
The U.S. Bureau of Labor Statistics (BLS) reports promising growth potential for RNs. The job outlook is expected to grow by about 6% between 2022 and 2032, a rate that’s faster than the average for all professions.
Seek a Path Forward in Case Utilization
Case utilization is an important field in the nursing world. It not only works to ensure that patients receive the care they need but also helps health care organizations use their resources as judiciously as possible. This facilitates the most efficient and effective care possible.
For those seeking work in this rewarding field, an important first step is to obtain the right education. The University of Tulsa’s online RN to BSN program can be a good option for those who already have some nursing experience but wish to advance their skills and elevate their credentials in as little as 12 months.
Explore the details of this online RN to BSN program today.
Recommended Readings
9 BSN Careers for Graduates to Consider
Advancement Opportunities for Registered Nurses in Oklahoma
Sources:
American Association of Colleges of Nursing, New Graduate Employment Data
American Nurses Association, What Is a Utilization Management Nurse?
Incredible Health, “Become a Utilization Review Nurse in 3 Steps”
Payscale, Average Utilization Review Nurse Salary
U.S. Bureau of Labor Statistics, Registered Nurses
ZipRecruiter, What Is a Utilization Management Nurse and How to Become One
