A Utilization Review RN is a specialized healthcare professional responsible for evaluating the medical necessity and efficiency of patient care. They collaborate with healthcare teams, insurance companies and patients to ensure that medical treatments and services are appropriate and cost-effective.

Essential Job Functions:

Utilization Review RNs play a crucial role in assessing patient care plans, reviewing medical records and ensuring

Utilization Review RNs review medical records, collaborate with healthcare teams to assess treatment plans, communicate with insurance companies to obtain authorization for procedures, ensure compliance with regulations and provide guidance on appropriate care and resource utilization.

Becoming a Utilization Review RN offers several advantages. It allows nurses to work in a non-clinical setting, contribute to cost-effective and quality patient care and utilize their clinical knowledge in a unique way. It also offers opportunities for remote work and flexible schedules.

However, the role may involve challenging conversations with healthcare providers and patients about treatment plans, denials and coverage.