Utilization Management Nurse Job Description

We have spoken about utilization review nurses, but now we will take a look at utilization management nurses. Things can be quite confusing for those who have no idea about how things work in the hierarchy of a health care center. Let's clear things out the UM nurse works inside the department of Utilization Management and she is coordinated by the clinical manager. Her main responsibility would be to assure medical outcomes characterized by cost efficiency and high quality to all those patients in need of an outpatient or inpatient preauthorization or pre-certification. She also has to screen the patients enrolled in the ICM programs.


Since you cannot be a nurse, either UR or UM or who know what else, without a degree, this is obviously what you will need. But besides this, some previous experiences regarding utilization management, of at least two years could help you a lot, just like some training. If you can make proof that you have real and solid competences in quality assurance, computer use, negotiations and outcomes case management, chances are you'll pass the interview with flying colors.

Depending on which state you apply for the job, a specific certification from the Board Registered Nurse could be required. Some employers even ask for a driver's license.

Job description

A utilization management nurse has to work in front of a computer for up to 8 hours a day. The main activity would be to check the intended requests for pre-certification that people do and, when some additional expertise is required, to refer them to the medical director. She also reviews all the information about the concurrent reviews, monitories the non-clinical activities of the staff, collaborates with doctors, patients, physicians, families, clients and customers. Still, it's more about papers than interacting with people because a lot of summaries, reports, balances and documents need to be written, monthly savings need to be prepared, record for every single medical interventions need to be done and inventories should be made.

Skills and competencies

It is management, so one cannot do all these without management skills, ability of coordinating teams, solving complex problems. Abstract, quick and active thinking are necessary. Being well organized, results- oriented, having negotiation skills, good communicational skills, both verbally and written, advocacy focus and empathy are mandatory. The ability of working under pressure, resistance to stress and to repetitive activity, computer skills and notions about managing conflicts could make the difference between being a successful utilization management nurse or a terrible one.

Working Environment

This job, as I was saying, is focused on writing papers for all the activities that normal nurses perform. Someone has to pay attention to all the facts and details, to make monthly or annual reports, to analyze complaints, to write reports, balances and all the other things that bureaucracy imposes on us. So the manager will spend a lot of time in front of a computer, typing data and numbers and answering phone calls. Sometimes, taking papers at home in order to review them will be a normal thing to do. Pressure can occur because of all the duties and tasks, mainly because some situations must be finalized up to a specific date. Many people will want to take some of your time and there will be moments when you'll feel like you don't have time to do all your tasks well. But with patience and calm, everything can be done. And you weren't named manager for nothing. You can succeed!