Utilization review nurses work with patients and medical staff to ensure that proper health care is provided and protocols are followed. They are responsible for the efficient allocation of a facility's resources. Utilization review nurses also maintain and report patient records.
Utilization review nurses explain medical treatments and hospital procedures to patients. They help people make informed decisions, preventing ill-advised or unnecessary therapy. They make recommendations based on information obtained from medical records and patient interviews. They manage patient care by conducting daily case reviews. They create discharge plans for patient transitions to home or other facilities.
These nurses ensure that proper procedures are followed and that resources are available for patients in the most critical condition. Utilization review nurses employed by insurance companies are responsible for verifying that patients qualify for benefits and certifying them for hospitalizations and surgeries. This sometimes requires traveling to meet with patients and healthcare providers. Most of these nurses work in hospitals, medical clinics or nursing homes. They provide information to insurance companies and healthcare facilities about patient admissions, lengths of stay, test results and medical procedures.
Utilization review nurses require strong communication and interpersonal skills. They often sit for long periods while doing research and writing reports. They must be adept at making decisions that balance the needs of patients and providers.