How much do utilization review nurses make?

Utilization review nurses make $75,000 per year. This career has an above-average growth in nursing salaries, which is likely linked to the nationwide shortage of nurses during the 2020 COVID-19 epidemic. However, nurses' salaries are expected to grow over the next decade.

Is being a utilization review nurse stressful?

Yes, being a utilization review nurse is stressful. Like most nursing roles, working as a utilization review nurse comes with a high stress level. Working as a utilization review nurse can be stressful, as it may involve situations and settings in which nurses must make difficult decisions that they may not personally agree with.

Is there a certification for utilization review nurses?

Yes, there is a certification for utilization review nurses. Since there is a specific utilization review certification, a person should enhance their qualifications by obtaining these additional certifications.

How To Become A Utilization Review Nurse: What It Is and Career Path

What is a utilization review nurse and how to become one

Updated January 8, 2025

5 min read

A utilization review nurse checks medical records and treatment plans to ensure that patients receive appropriate care with manageable healthcare costs. They work for insurance companies, hospitals, or healthcare organizations. Utilization review nurses evaluate the medical necessity of procedures, medications, and tests. They also educate patients and their families on health management and help them navigate the healthcare system. A utilization review nurse ensures that patients receive high-quality care while minimizing healthcare costs.

ScoreUtilization Review NurseUS Average

Salary

5.1

Avg. Salary $65,425

Avg. Salary $59,228

Stability level

10.0

Growth rate 6%

Growth rate 0.3%

Diversity

6.3

Race

American Indian and Alaska Native 0.44%

Asian 8.87%

Black or African American 11.98%

Hispanic or Latino 9.10%

Unknown 4.27%

White 65.34%

Gender

female 91.54%

male 8.46%

Age - 43

Race

American Indian and Alaska Native 3.00%

Asian 7.00%

Black or African American 14.00%

Hispanic or Latino 19.00%

White 57.00%

Gender

female 47.00%

male 53.00%

Age - 43

Stress level

10.0

Stress level is very high

7.1 - high

Complexity level

9.1

Complexity level is advanced

7 - challenging

Work life balance

7.8

Work life balance is good

6.4 - fair

What are the pros and cons of being a utilization review nurse?

Pros

Competitive salaries and benefits
Opportunities for career advancement and professional development
High demand for skilled utilization review nurses
Exposure to a wide range of medical conditions and treatments
Opportunities to learn about cutting-edge medical technologies and procedures

Cons

Risk of burnout due to long hours and high patient caseloads
Emotionally challenging work due to dealing with patients' health issues
Dealing with difficult patients or families can be emotionally draining
Potential for conflict with insurance companies or healthcare providers over treatment decisions
Risk of exposure to infectious diseases or hazardous materials in certain work environments

Key steps to become a utilization review nurse

Explore utilization review nurse education requirements

Most common utilization review nurse degrees

Bachelor's

42.6 %

Associate

36.6 %

Diploma

9.1 %

Start to develop specific utilization review nurse skills

Skills	Percentages
Medical Necessity	9.02%
Patients	7.40%
Acute Care	7.39%
Discharge Planning	7.16%
Utilization Management	6.40%

Complete relevant utilization review nurse training and internships

Accountants spend an average of 3-6 months on post-employment, on-the-job training. New utilization review nurses learn the skills and techniques required for their job and employer during this time. The chart below shows how long it takes to gain competency as a utilization review nurse based on U.S. Bureau of Labor Statistics data and data from real utilization review nurse resumes.

Gain additional utilization review nurse certifications

Utilization review nurse certifications can show employers you have a baseline of knowledge expected for the position. Certifications can also make you a more competitive candidate. Even if employers don't require a specific utilization review nurse certification, having one may help you stand out relative to other applicants.

The most common certifications for utilization review nurses include Certified Case Manager (ACM) and Legal Nurse Consultant Certified (LNCC).

More About Certifications

Research utilization review nurse duties and responsibilities

Monitor patients' status during surgery (circulate in operating room) and manage patients in PACU.
Case management for acute patients refer to LTC
Advise insurance carriers on recommend reimbursement for charges following automate bill audit utilizing ICD-9 and CPT codes.
Provide caregiver oversight relate to care, medication administration and emergency situations.

Prepare your utilization review nurse resume

When your background is strong enough, you can start writing your utilization review nurse resume.

You can use Zippia's AI resume builder to make the resume writing process easier while also making sure that you include key information that hiring managers expect to see on a utilization review nurse resume. You'll find resume tips and examples of skills, responsibilities, and summaries, all provided by Zippi, your career sidekick.

Choose from 10+ customizable utilization review nurse resume templates

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