Utilization review nurses find employment opportunities with hospitals, nursing homes, insurance companies, corrections facilities and the military. In these positions, utilization review nurses analyze patient medical records to determine the appropriate level of care while balancing costs.Continue Reading
When employed by medical care providers, such as hospitals, utilization review nurses assess patient files to determine the need for tests, treatments and medications. This serves to minimize unnecessary costs for care providers and patients. In addition, these nurses regularly communicate with utilization review nurses employed by insurance companies to ensure compliance with reimbursement requirements.
Insurance companies employ utilization review nurses to analyze medical claims and determine whether to accept or deny coverage for treatments. These nurses consider the individual circumstances of each patient and balance those circumstances with insurance policies and costs.
Regardless of the employer, all utilization review nurses hold current nursing licenses. They possess sufficient experience and knowledge to work effectively with doctors and insurance companies, and they aim to reach fair and objective decisions concerning the best plan of care.Learn more about Careers