Utilization Review Jobs

Utilization Review Nursing Jobs

Utilization Review nurses are nurses with a few years of clinical experience who specialize in reimbursement polices and procedures. These nurses work closely with the managed care professionals to ensure the hospital is paid for services rendered to the patients. Utilization review nurses perform no direct patient care. This position literally ensures that all hospital services were properly utilized and that every procedure, test, drug, and staff member was absolutely necessary for the patient's care and all documentation properly signed off on to guarantee payment by insurance companies. The utilization nurse can expect to sit on various committees involving nursing, pharmacy, managed care, and administration. These nurses may also sit on performance review committees which oversee department as well as individual performances in all aspects of healthcare provision within the hospital. The goal of the utilization review nurse is to make certain the hospital receives optimal compensation for services rendered to the patient.

Utilization Review Organizations and Associations

American Nurses Association (ANA)

8515 Georgia Avenue Suite 400
Silver Spring, MD 20910

Website:

http://ana.org/

Phone:

(301) 628-5000