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This question is about utilization review nurse resumes.
What are the responsibilities of a utilization review nurse?
The responsibilities of a utilization review nurse focus on identifying appropriate levels of patient care. They communicate with both doctors and insurance providers to coordinate proper patient care and coverage.
The primary responsibility of the UR nurse is to assess each patient's case and compare the care plan for that patient to established protocols. If a care plan deviates from the protocol, you will consult both doctors and nurses to determine if the deviation is warranted.
Most of the time, patients are placed in the proper level of care, but occasionally a UR nurse must determine if the length of stay should be extended or shortened.
UR nurses working in hospitals must also communicate with their counterparts employed by private insurers. This will determine if the changes made to a patient care plan will be covered by the insurance provider.
A UR nurse working for an insurer is responsible for reviewing procedures and tests ordered by the hospital and determining if they are appropriate based on the patient's case file. It is their job to advocate for the company and reduce unnecessary expenditures.
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