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Become An Utilization Review Coordinator

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Working As An Utilization Review Coordinator

  • Assisting and Caring for Others
  • Documenting/Recording Information
  • Getting Information
  • Making Decisions and Solving Problems
  • Updating and Using Relevant Knowledge
  • Deal with People

  • Unpleasant/Angry People

  • Unpleasant/Hazardous Environment

  • Make Decisions

  • $67,490

    Average Salary

What Does An Utilization Review Coordinator Do

Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.


Registered nurses typically do the following:

  • Record patients’ medical histories and symptoms
  • Administer patients’ medicines and treatments
  • Set up plans for patients’ care or contribute to existing plans
  • Observe patients and record the observations
  • Consult and collaborate with doctors and other healthcare professionals
  • Operate and monitor medical equipment
  • Help perform diagnostic tests and analyze the results
  • Teach patients and their families how to manage illnesses or injuries
  • Explain what to do at home after treatment

Most registered nurses work as part of a team with physicians and other healthcare specialists. Some registered nurses oversee licensed practical nurses, nursing assistants, and home health aides.

Registered nurses’ duties and titles often depend on where they work and the patients they work with. For example, an oncology nurse may work with cancer patients or a geriatric nurse may work with elderly patients. Some registered nurses combine one or more areas of practice. For example, a pediatric oncology nurse works with children and teens who have cancer.

Many possibilities for working with specific patient groups exist. The following list includes just a few examples:

Addiction nurses care for patients who need help to overcome addictions to alcohol, drugs, and other substances.

Cardiovascular nurses care for patients with heart disease and people who have had heart surgery.

Critical care nurses work in intensive-care units in hospitals, providing care to patients with serious, complex, and acute illnesses and injuries that need very close monitoring and treatment.

Genetics nurses provide screening, counseling, and treatment for patients with genetic disorders, such as cystic fibrosis.

Neonatology nurses take care of newborn babies.

Nephrology nurses care for patients who have kidney-related health issues stemming from diabetes, high blood pressure, substance abuse, or other causes.

Rehabilitation nurses care for patients with temporary or permanent disabilities.

Registered nurses may work to promote public health, by educating people on warning signs and symptoms of disease or managing chronic health conditions. They may also run health screenings, immunization clinics, blood drives, or other community outreach programs. Other nurses staff the health clinics in schools.

Some nurses do not work directly with patients, but they must still have an active registered nurse license. For example, they may work as nurse educators, healthcare consultants, public policy advisors, researchers, hospital administrators, salespeople for pharmaceutical and medical supply companies, or as medical writers and editors.

Clinical nurse specialists (CNSs) are a type of advanced practice registered nurse (APRN). They provide direct patient care in one of many nursing specialties, such as psychiatric-mental health or pediatrics. CNSs also provide indirect care, by working with other nurses and various other staff to improve the quality of care that patients receive. They often serve in leadership roles and may educate and advise other nursing staff. CNSs also may conduct research and may advocate for certain policies.

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How To Become An Utilization Review Coordinator

Registered nurses usually take one of three education paths: a Bachelor of Science degree in nursing (BSN), an associate’s degree in nursing (ADN), or a diploma from an approved nursing program. Registered nurses also must be licensed.


In all nursing education programs, students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, and other social and behavioral sciences, as well as in liberal arts. BSN programs typically take 4 years to complete; ADN and diploma programs usually take 2 to 3 years to complete. All programs include supervised clinical experience.

Bachelor’s degree programs usually include additional education in the physical and social sciences, communication, leadership, and critical thinking. These programs also offer more clinical experience in nonhospital settings. A bachelor’s degree or higher is often necessary for administrative positions, research, consulting, and teaching.

Generally, licensed graduates of any of the three types of education programs (bachelor’s, associate’s, or diploma) qualify for entry-level positions as a staff nurse. However, employers—particularly those in hospitals—may require a bachelor’s degree.

Many registered nurses with an ADN or diploma choose to go back to school to earn a bachelor’s degree through an RN-to-BSN program. There are also master’s degree programs in nursing, combined bachelor’s and master’s programs, and accelerated programs for those who wish to enter the nursing profession and already hold a bachelor’s degree in another field. Some employers offer tuition reimbursement.

Clinical nurse specialists (CNSs) must earn a master’s degree in nursing and typically already have 1 or more years of work experience as an RN or in a related field. CNSs who conduct research typically need a doctoral degree.

Licenses, Certifications, and Registrations

In all states, the District of Columbia, and U.S. territories, registered nurses must have a nursing license. To become licensed, nurses must graduate from an approved nursing program and pass the National Council Licensure Examination (NCLEX-RN).

Other requirements for licensing vary by state. Each state’s board of nursing can give details. For more information on the NCLEX-RN and a list of state boards of nursing, visit the National Council of State Boards of Nursing.

Nurses may become certified through professional associations in specific areas, such as ambulatory care, gerontology, and pediatrics, among others. Although certification is usually voluntary, it demonstrates adherence to a higher standard, and some employers require it.

CNSs must satisfy additional state licensing requirements, such as earning specialty certifications. Contact state boards of nursing for specific requirements.

Important Qualities

Critical-thinking skills. Registered nurses must be able to assess changes in the health status of patients, including determining when to take corrective action and when to make referrals.

Communication skills. Registered nurses must be able to communicate effectively with patients in order to understand their concerns and assess their health conditions. Nurses need to explain instructions, such as how to take medication, clearly. They must be able to work in teams with other health professionals and communicate the patients’ needs.

Compassion. Registered nurses should be caring and empathetic when caring for patients.

Detail oriented. Registered nurses must be responsible and detail oriented because they must make sure that patients get the correct treatments and medicines at the right time.

Emotional stability. Registered nurses need emotional resilience and the ability to manage their emotions to cope with human suffering, emergencies, and other stresses.

Organizational skills. Nurses often work with multiple patients with various health needs. Organizational skills are critical to ensure that each patient is given appropriate care.

Physical stamina. Nurses should be comfortable performing physical tasks, such as moving patients. They may be on their feet for most of their shift.


Most registered nurses begin as staff nurses in hospitals or community health settings. With experience, good performance, and continuous education, they can move to other settings or be promoted to positions with more responsibility.

In management, nurses can advance from assistant clinical nurse manager, charge nurse, or head nurse to more senior-level administrative roles, such as assistant director or director of nursing, vice president of nursing, or chief nursing officer. Increasingly, management-level nursing positions are requiring a graduate degree in nursing or health services administration. Administrative positions require leadership, communication skills, negotiation skills, and good judgment.

Some nurses move into the business side of healthcare. Their nursing expertise and experience on a healthcare team equip them to manage ambulatory, acute, home-based, and chronic care businesses. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need registered nurses for jobs in health planning and development, marketing, consulting, policy development, and quality assurance.

Some RNs choose to become nurse anesthetists, nurse midwives, or nurse practitioners, which, along with clinical nurse specialists, are types of advanced practice registered nurses (APRNs). APRNs may provide primary and specialty care, and in many states they may prescribe medications.

Other nurses work as postsecondary teachers in colleges and universities.

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Utilization Review Coordinator Jobs


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Utilization Review Coordinator Career Paths

Utilization Review Coordinator
Registered Nurse Case Manager Nursing Director
Chief Nursing Officer
14 Yearsyrs
Medical Coder Adjunct Instructor Clinical Social Worker
Clinical Care Manager
8 Yearsyrs
Utilization Review Nurse Registered Nurse Case Manager Nursing Director
Clinical Services Director
11 Yearsyrs
Nurse Staff Nurse Case Manager
Director Of Case Management
11 Yearsyrs
Director Of Case Management Managing Director Senior Recruiter
Director Of Human Resources
10 Yearsyrs
Home Health Nurse Nursing Director Clinical Coordinator
Director Of Pharmacist
10 Yearsyrs
Home Health Nurse Registered Nurse Supervisor Nursing Director
Director Of Quality Management
13 Yearsyrs
Career Manager Operations Manager General Manager
Director Of Sales
10 Yearsyrs
Nurse Case Manager Case Manager Account Manager
District Sales Manager
7 Yearsyrs
Medical Coder Nurse Career Manager
Managed Care Director
8 Yearsyrs
Director Of Case Management Social Worker Clinical Director
Medical Director
9 Yearsyrs
Registered Nurse Case Manager Clinical Supervisor Program Director
Operations Director
9 Yearsyrs
Utilization Review Nurse Staff Nurse Instructor
Operations Manager
7 Yearsyrs
Career Coordinator Assistant Director Of Nursing Registered Nurse Case Manager
Patient Care Manager
9 Yearsyrs
Nurse Case Manager Registered Nurse Case Manager Patient Care Manager
Patient Relations Director
10 Yearsyrs
Quality Assurance Coordinator Quality Assurance Account Manager
Regional Accounts Manager
8 Yearsyrs
Quality Assurance Coordinator Quality Assurance Manager General Manager
Regional Director Of Operations
11 Yearsyrs
Career Coordinator Program Manager Marketing Manager
Regional Sales Manager
9 Yearsyrs
Nurse Case Manager Program Manager
Senior Manager
10 Yearsyrs
Career Manager Clinical Supervisor Program Manager
Vice President, Business Development
13 Yearsyrs
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Utilization Review Coordinator Demographics










Hispanic or Latino


Black or African American





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Utilization Review Coordinator Education


University of Phoenix


Florida International University


Walden University


Grand Canyon University


University of Memphis


Strayer University


University of Texas at Arlington


Capella University


Northeastern University


Indiana Wesleyan University


Wayne State University


University of Maryland - University College


Webster University


Troy University


Florida State University


George Mason University


Excelsior College


University of Oklahoma


University of South Florida


Lansing Community College

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Health Care Administration


Social Work




School Counseling


Counseling Psychology


Mental Health Counseling






Computer Information Systems


Clinical Psychology


General Studies


Criminal Justice


Medical Assisting Services




Public Health


Liberal Arts




Human Services

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Real Utilization Review Coordinator Salaries

Job Title Company Location Start Date Salary
Utilization Review Coordinator Promptcare Health Services, Inc. Glendale, CA May 20, 2013 $71,760
Utilization Review Coordinator Promptcare Health Services, Inc. Glendale, CA May 19, 2012 $71,760
Utilization Review Coordinator Promptcare Health Services, Inc. Glendale, CA May 20, 2011 $71,760
Utilization Review Coordinator Promptcare Health Services, Inc. Glendale, CA May 21, 2010 $71,760
Utilization Review Coordinator Holzer Medical Center Jackson Jackson, OH Jan 27, 2011 $62,400
Utilization Review Coordinator Mission Hills Health Care Center San Diego, CA Oct 01, 2009 $61,859
Qa/Utilization Review Coordinator Jopal at St. James, LLC Saint James, NY Dec 15, 2011 $59,530
Utilization Review Coordinator Commonwealth Healthcare Corporation Apr 21, 2014 $42,000 -
Utilization Review Coordinator Commonwealth Healthcare Corporation Apr 21, 2014 $40,000 -
Utilization Review Coordinator Commonwealth Healthcare Corporation Mar 24, 2014 $40,000 -

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Top Skills for An Utilization Review Coordinator

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  1. Utilization Review
  2. Insurance Companies
  3. Medical Records
You can check out examples of real life uses of top skills on resumes here:
  • Performed utilization review for renowned eating disorder facility to en- sure quality and procure funds to fuel operations.
  • Communicate with insurance companies to complete concurrent or step down reviews to request additional time for patients in detoxification or rehabilitation.
  • Organized medical records and confidential data and prepared accounts receivable and expected revenue reports for controllers.
  • Verified prior medical and retro-claims for medical services, eligibility, medical groups, and hospital payment modifications.
  • Coordinated safe and appropriated discharge planning with patients, family members, providers and insurance companies decreasing unapproved hospital days.

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Top Utilization Review Coordinator Employers

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Utilization Review Coordinator Videos

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