Pros and Cons of Being a Utilization Management Nurse + Salary + Steps to Become

Written By: Jennifer SchletteJennifer Schlette MSN, RN

Jennifer Schlette is a registered nurse in pediatric critical care in New York City. She is the former Director of Undergraduate Nursing at a college located in New York. After obtaining her BSN from the College of Mount Saint Vincent, she went on to complete her MSN. Jennifer also freelances as a fact-checker for a mother’s advice publication. Read Full Bio »» MSN, RN

If you are anything like me, then the words "utilization management" make your eyes glaze over. It sounds about as interesting as watching paint dry, right? But despite its unappealing name, utilization management nursing is an important and growing field. So if you are thinking of becoming a utilization management nurse, or are curious about what a utilization management nurse does day-to-day, read on! Let me ask you a question first, do you know what are the pros and cons of being a utilization management nurse?

This blog post will outline the top 10 pros and cons of being a utilization management nurse + salary + steps to become one. Let's get to it!

What Exactly is a Utilization Management Nurse?

A utilization management nurse is a registered nurse who works with health insurance companies to ensure that patients receive the care they need and that this care is being provided cost-effectively. These nurses typically have experience working in a hospital setting and are familiar with the various treatments and procedures available.

As a utilization management nurse, you will be completing three different types of reviews:

1. Prospective Review:

A prospective review is when you will analyze a patient's case and the medical team's proposed treatment plan. The primary purpose of this type of review is to eliminate unneeded, ineffective, or duplicate treatments. A prospective review is used during routine and urgent referrals. The review will always begin before the treatment begins. This is sometimes referred to as prior authorization.

2. Concurrent Review:

You will perform a concurrent review while treatment is in progress. The main focus of this type of review is to track the utilization of resources and the patient's progress and reduce denials of coverage after the treatment is complete.

3. Retrospective Review:

You will perform a retrospective review after completing the treatment. This type of review aims to assess the appropriateness, effectiveness, and timing of treatments, as well as the setting in which the treatment was delivered.

The goal of a retrospective review is to determine which treatments work best. This is because these treatments can be prescribed to similar patients in the future. It allows the utilization management nurse to find problems and successes and send that data back to caregivers.

Suppose proven treatments are not used for a patient, and a claim is denied. In that case, the financial responsibility falls on the caregiver. The process of retrospective review also looks to ensure that reimbursements are accurate and if a claim should be denied.

What Does a Utilization Management Nurse Do?

Before you become a utilization management nurse, I am sure you want to know what a utilization management nurse does. So, I am going to let you know. Below you will find the duties of a utilization management nurse.

1. Reviewing patient records:

As a utilization management nurse, you will be responsible for reviewing patient records and making decisions about coverage based on the information contained therein. This will require you to thoroughly understand the case's clinical aspects and relevant insurance regulations.

2. Making determinations about the necessary level of care:

Utilization management is the process of reviewing and evaluating the medical necessity, appropriateness, and effectiveness of healthcare services. As a utilization management nurse, you will be responsible for deciding what level of care is necessary for each patient. This may include making decisions about whether a patient should be admitted to the hospital, whether they can be discharged to a less intensive level of care, or whether they can be managed as outpatients.

3. Coordinating care between different providers:

As a utilization management nurse, you will be responsible for coordinating care between various providers. This may involve working with physicians, hospitals, and other health care providers to ensure timely and efficient services.

4. Leading and directing the utilization review staff at a health care facility:

Leading and directing the utilization review staff at a health care facility is one of your duties as a utilization management nurse. You are responsible for ensuring that staff members are appropriately trained and follow all policies and procedures. Additionally, you must keep up with changes in the healthcare industry and ensure that your facility is compliant. This position requires excellent communication and organizational skills.

5. Determining procedures and policies that best ensure effective utilization:

As a utilization management nurse, you will be responsible for deciding practices and policies that best ensure effective utilization. In order to do this, you will need to have a strong understanding of the healthcare system and how it works. You will also need to be familiar with the available types of insurance and how they work. Additionally, you will need to be able to effectively communicate with both medical staff and patients.

6. Monitoring reviews to ensure patients receive care in a timely and cost-effective manner:

Another of your duties as a utilization management nurse will be to monitor patient care reviews to ensure that patients are receiving care in a timely and cost-effective manner. You will need to be familiar with the different types of care available to patients and the cost implications. In addition, you will need to be able to work closely with the patient's physician to ensure that the care plan is appropriate for the patient's needs.

7. Preparing analysis and reports on significant utilization trends and effects on resources:

Preparing analysis and reports on significant utilization trends and their impacts on resources is another one of your duties as a utilization management nurse. You will be expected to identify any problems or issues with resource utilization and make recommendations to improve the situation. In some cases, you may also be asked to present your findings to upper management or other key decision-makers. This is an essential part of the job as it can help improve the quality of care and save money for the organization.

8. Consulting with physicians and other professionals to improve utilization of services:

Consulting with physicians and other professionals to improve utilization of services will be another one of your responsibilities as a utilization management nurse. You will work to ensure that services are being used appropriately and efficiently in order to optimize patient care. This will involve communicating with providers, conducting Utilization Reviews, and making recommendations for improvement.

9. Creating a utilization review system for the facility and training team members on it:

As a utilization management nurse, you will be responsible for creating a utilization review system for the facility. This system will help ensure that all services are utilized most efficiently and effectively possible. You will also be responsible for training team members on how to use this system.

Where Does a Utilization Management Nurse Work?

When you are deciding on becoming a utilization management nurse, it is important to know what this job entails and where you will be working. Utilization management nurses work in many different places. Here is a look at some of the most common areas in these nurses' work:

1. Hospitals:

One of the settings a Utilization Management Nurse may work in is a hospital. The main goal of a Utilization Management Nurse working in a hospital is to ensure that the patients can receive the care they need while also ensuring that the hospital is not overspending on resources. Utilization Management Nurses working in hospitals typically create reports detailing the utilization of resources and make recommendations to the hospital staff on how to improve resource utilization.

2. Nursing Homes:

Nursing homes are another setting you may work in as a utilization management nurse. In this role, you will be responsible for ensuring that residents receive the care and services they need while also working to improve the overall quality of care in the nursing home. This can be a challenging and rewarding position, as you will be able to make a real difference in the lives of those who reside in the nursing home.

3. Home:

Working from home is another environment you may find yourself in as a Utilization Management Nurse. In this instance, you would work with a team of nurses remotely to ensure that patients get the care they need and deserve. You would still be responsible for conducting reviews, making recommendations, and collaborating with the care team.

4. Insurance companies:

Insurance companies are the most common environments to employ utilization management nurses. These nurses liaise between the patient and the insurance company to ensure that the company will cover medically necessary treatments. Utilization management nurses review patients' records to ensure they meet the coverage requirements. If a patient does not meet the requirements, the nurse works with the provider to determine an alternative plan of care that will be covered. Utilization management nurses also work with patients to educate them about their coverage and help them navigate the claims process.

What is the Typical Work Schedule of a Utilization Management Nurse?

The typical work schedule for a nurse working in utilization management is Monday through Friday, eight to ten-hour days. There is some flexibility in the schedule. However, most nurses in this capacity find that having a set schedule helps them better manage their time and workload. Utilization management nurses may also be required to work weekends and holidays as needed but not very often. Some nurses working in this field may also be on call for after-hours coverage.

What are the Most Important Skills and Abilities Required to Successfully Work as a Utilization Management Nurse?

1. Communication:

You will need excellent communication skills to work as a utilization management nurse and be successful. Strong communication skills are essential in this role, as utilization management nurses must effectively communicate with patients, families, physicians, and other healthcare team members. Utilization management nurses must also be able to clearly document patient care plans and communicate their recommendations to insurance companies.

2. Strong knowledge of word processing and spreadsheet computer programs:

A Strong knowledge of word processing and spreadsheet computer programs is necessary to successfully work as a utilization management nurse. You will also need to be able to keep accurate records and manage financial resources. Computer programs like Microsoft Word and Excel can help nurses in these roles keep track of essential data.

3. Collaboration:

Collaboration is an essential skill that you will need to work as a utilization management nurse. You will need to be able to work with other nurses, doctors, and staff in order to coordinate care for patients. This can be a challenging skill to master, but it is essential for success in this field.

4. Time management:

Time management is an important skill to have if you want to be successful in any field. But it is imperative if you are working as a utilization management nurse. Utilization management nurses are responsible for coordinating care and ensuring that patients receive the most appropriate level of care for their needs. This can be a very demanding job, and if you do not have good time management skills, it can be challenging to keep up with everything that needs to be done.

5. Empathy:

Being a utilization management nurse requires being able to see both sides of every situation. You will need to be able to understand the perspective of the patient, as well as the doctor's orders.

6. Detailed-oriented:

Being detail-oriented is one of the most important skills that a Utilization Management Nurse can have. This is because, in order to be successful in this position, you will need to be able to review medical records and other documentation in order to make determinations about a patient's care. This means that you will need to be able to pay close attention to detail in order to ensure that you are making the correct decisions about a patient's care.

7. Analytical skills:

Analytical skills are must-have skills for any Utilization Management Nurse. You will need to be able to understand and interpret data to make recommendations to improve patient care. This data can come in many forms, including medical records, laboratory results, and insurance claims.

8. Organizational skills:

Utilization management nurses need to be organized to track all the different patients and their care plans. If you do not have good organizational skills, then mistakes can happen. You may also be creating more work for yourself in the long run.

How Much Does a Utilization Management Nurse Make?

So, I guess now would be an excellent time to dive into the question of how much does a utilization management nurse make. The average utilization management nurse salary is $90,191 a year. This will break down to be $43.36 or $7,520.

The entry-level wage you would earn if you were starting out in the profession is $29.84 an hour or $5,170 a month. This would be an annual salary of $62,060.

After you have been working anywhere from one to four years, you can expect an annual salary of $67,560. This is $32.48 an hour or $5,630 a month. Once you gain a bit more experience, you can expect your hourly salary to increase to $39.57, which is a monthly income of $6,860. This means your yearly earnings will also increase to $82,300.

Utilization management nurses who have been in the profession for ten to nineteen years will also see an increase in their annual salary to $102,440. This yearly salary will break down to $49.25 an hour or $8,540 monthly. Utilization management nurses with twenty or more years of experience will also be earning a six-figure annual salary. You would be making $131,120 a year or $10,930 a month. This is an hourly wage of $63.04.

Level of Experience	Hourly	Monthly	Annual
Entry-Level	$29.84	$5,170	$62,060
1-4 Years of Experience	$32.48	$5,630	$67,560
5-9 Years of Experience	$39.57	$6,860	$82,300
10-19 Years of Experience	$49.25	$8,540	$102,440
20 Years or More Experience	$63.04	$10,930	$131,120
Average Salary	$43.36	$7,520	$90,191

Is There a Demand For Utilization Management Nurses?

Having a demand in your specific career field is essential to know when you are making plans to enter the workforce. It can be challenging to find a job if there is no demand for your skill set in the current market. The same goes for utilization management nurses. But is there a demand for these types of nurses? Well, the answer is yes. Below you will find the reasons why utilization management nurses are in demand.

1. Health reform:

Health reform will increase the demand for utilization management nurses, who will play a vital role in ensuring that patients receive the most appropriate care at the most appropriate time. Utilization management nurses are experts in coordinating care and managing the utilization of resources. They will be uniquely positioned to help contain costs and improve quality in the new health care landscape.

2. The Patient Protection and Affordable Care Act:

The Patient Protection and Affordable Care Act (PPACA) will increase the number of Americans with health insurance coverage. As a result, there will be an increased demand for health care services. In order to ensure that these services are delivered cost-effectively, utilization management will become increasingly important.

What is the Step-By-Step Process to Become a Utilization Management Nurse?

1. The first step toward becoming a utilization management nurse is earning either your Associate’s degree in nursing or your Bachelor of Science in Nursing degree (BSN) from an accredited institution. Earning this degree will provide you with the foundational knowledge as well as prepare you for your role as a nurse.

2. Next, you will need to pass the National Certification Licensure Exam (NCLEX-RN).

3. Once you have passed the NCLEX-RN, you can then apply for a license through the state board of nursing of the state you plan to practice in.

4. Depending on where you work, you may be required to earn your Basic Life Support Certification (BLS).

5. You should strongly consider becoming certified. The two certifications you should pursue are Health Care Quality and Management (HCQM) Board Certification and Health Utilization Management (HUM) Certifications. You can also attain earning certification as a Certified Case Management (CCM) certification.

Top Cons of Being a Utilization Management Nurse

(The following are the top 10 disadvantages of being a Utilization Management Nurse.)

1. You will most likely need to earn your bachelor’s degree

One of the cons of being a utilization management nurse is that you will most likely have to make your bachelor's degree. Most employers are looking to hire utilization management nurses who hold this degree. You can work as a utilization management nurse with an associate, but good luck finding that dream job.

2. It can be some pretty isolating work.

Being a Utilization Management Nurse who works from home can be isolating. You do not have any co-workers to vent to when things get frustrating. And, you never get to see the people you help. It is just you and your computer all day long.

Isolation can lead to feeling disconnected from what is going on in the world. You can feel like you are not a part of anything. This can be depressing and make it hard to want to get out of bed some days.

3. Your day will not have many variations.

One of the disadvantages of being a utilization management nurse is that your day can be quite repetitive. You will likely find yourself doing the same tasks over and over again. This can lead to boredom and a feeling of stagnation. If you are not careful, this can eventually lead to burnout.

4. You will have a steep learning code.

As Utilization Management Nurse, you will have a steep learning curve. The downside is that your expectations will be high, and there is little room for error. There is also a lot of paperwork and red tape to navigate. Suppose you are unable to adapt to this steep learning curve, well. In that case, your career as a Utilization Management Nurse will be short-lived.

5. You will be on the phone a lot.

Another one of the cons of being a utilization management nurse is that you will be on the phone a lot. If you do not like talking on the phone, this might not be your job. You will find that you will be making multiple phone calls during the day, and sometimes the calls can be quite lengthy. There are also times when you will have to make calls outside of regular business hours, so you need to be prepared for that as well.

6. If you work from home, you will need a dedicated workspace

A Utilization Management Nurse working from home must make a dedicated workspace. This could pose some problems if you live in a small house. You just may not have the resources to do so. You will also need to have access to a computer, printer, and internet. This is no small undertaking. It can be time-consuming and expensive.

7. You will have deadlines to meet.

One of the top cons of being a utilization management nurse is that you have deadlines that need to be met. These deadlines can be stringent, and if you do not meet them, it can negatively impact your career.

8. You may have a lot of juggling to do

As a Utilization Management Nurse, you will have much to juggle. You will need to be able to prioritize your time and your caseload. If you are unable to prioritize your time, you will not be successful in this role. You will also need to be very organized. You will need to keep track of your caseload, deadlines, and paperwork. You will quickly become overwhelmed and bogged down in your work if you are not organized.

9. Your day may not end at 5 pm.

One of the biggest disadvantages of being a utilization management nurse is that your day may not end at 5 pm. You will often find yourself answering emails and phone calls on your time off. This can be very frustrating, especially if you are trying to enjoy your time off.

10. Working from home may not be all cracked up as your thought.

As Utilization Management Nurse, working from home may not be all cracked up as your thought. Sure, you can wear your comfy clothes and listen to music all day, but big brother is always watching you. Your every move is monitored and reviewed to ensure that you are providing the best possible care for your patients and that you are being productive. So, if you are thinking of working from home, be prepared to have someone constantly looking over your shoulder.

Top Pros of Being a Utilization Management Nurse

(The following are the top 10 advantages of being a Utilization Management Nurse.)

1. You will earn an excellent salary.

One of the pros of being a utilization management nurse is that you will earn an excellent salary. You will be able to afford the finer things in life and enjoy a comfortable lifestyle. You will be able to own a lovely home and a nice car and go on some great vacations. You'll have a lot of disposable income, and you'll be able to live a very nice lifestyle. So, if you are looking for a high-paying career, utilization management nursing may be the right choice for you.

2. You will not have to work weekends or holidays.

As Utilization Management Nurse, you will not have to work weekends or holidays. You will have a regular schedule that allows you to enjoy your weekends and holidays. You will not miss out on time and events with family and friends. You will be able to live a normal, healthy lifestyle that includes weekends and holidays.

3. You will have more flexibility in your life.

Another one of the pros of being a utilization management nurse is the increased flexibility you'll have in your life. With a more traditional nursing job, you might be tied down to working long hours with little free time. However, as a utilization management nurse, you will have much more control over your schedule. This means that depending on where you work, you can pick and choose when you want to work and have plenty of time for your family and other interests outside of work. Suppose you are looking for a nursing career that offers more flexibility. In that case, utilization management nursing could be the perfect fit for you.

4. You will find a job anywhere.

As Utilization Management Nurse, you can find a job anywhere. All parts of the country will require your services as a utilization management nurse. You can pick where you want to live and work because you are in such high demand.

5. You could choose the setting you want to work in

There is no need to limit yourself to one place when you are a utilization management nurse. You can find opportunities in various settings, from hospitals and clinics to insurance companies and government agencies. Wherever nurses need to coordinate and manage patient care, there is a potential job for you.

6. You may be able to work from home.

One of the biggest advantages of being a utilization management nurse is that you may be able to work from home. This can be a great perk, especially if you have young children at home. You will be able to save on childcare costs and have more flexibility with your schedule.

Another advantage of working from home is that you can avoid the daily commute. This can save you a lot of time and money and can be less stressful than dealing with traffic and other commute-related issues.

7. You will not have to provide hands-on nursing care

As Utilization Management Nurse, you will not have to provide hands-on nursing care. You will be working behind the scenes to ensure that patients receive the care they need, while also maximizing the efficiency of the healthcare system. This means that you will not be at an increased risk of infections. In fact, you may even find that your work helps to prevent the spread of diseases.

8. You will not have the same types of stress you would working bedside.

One of the top pros of being a utilization management nurse is that you will not have the same types of stresses you would working bedside. Of course, you will still have some pressure, but it will be more manageable and less intense. This is because you will not be dealing with sick or injured patients on a daily basis. Instead, you will be working with insurance companies and reviewing medical records.

While this may not sound like the most exciting job in the world, it can be very rewarding. Utilization management nurses often have a lot of autonomy and can make a real difference in the quality of healthcare patients receive.

9. You will be improving the healthcare system.

As Utilization Management Nurse, you will improve the healthcare system by ensuring that patients receive the care they need when they need it. You will also be working to ensure that healthcare resources are used efficiently and effectively. In this role, you will be working closely with doctors, nurses, and other health care professionals to ensure that patients receive the best possible care. That has got to feel great!

10. Your job will not be physically demanding.

Another one of the advantages of being a utilization management nurse is that your job will not be physically demanding. You won't have to lift heavy objects or stand for long periods of time. This means you'll be able to avoid some of the common injuries that nurses often suffer.

Breaking Down the Salary of a Utilization Management Nurse

What Is The Starting Salary Of A Utilization Management Nurse?

The starting salary of a utilization management nurse is $29.84 an hour or $1,193 a week. This will work out to be $5,170 a month or an annual salary of $62,060.

Hourly	$29.84
Weekly	$1,193
Monthly	$5,170
Annual	$62,060

What Is The Average Salary Of A Utilization Management Nurse?

The average utilization management nurse salary is $43.36 an hour or $1,734 a week. This means that you will be earning $7,520 a month or an annual income of $90,191.

Hourly	$43.36
Weekly	$1,734
Monthly	$7,520
Annual	$90,191
(Source: Ziprecruiter.com)

What Is The Average Utilization Management Nurse Salary In Your State?

In the world of utilization management nursing, your salary will differ depending on which state you practice in. Alabama will have you earning a salary of $67,800 a year. Now, in California, you will make more than double the compensation in Alabama. In California, you will be earning $135,110. What is crazy about these figures is that you are essentially performing the same job with a different salary.

State	Hourly	Monthly	Annual
Alabama	$32.60	$5,650	$67,800
Alaska	$50.33	$8,720	$104,680
Arizona	$42.25	$7,320	$87,890
Arkansas	$32.41	$5,620	$67,410
California	$64.96	$11,260	$135,110
Colorado	$42.18	$7,310	$87,740
Connecticut	$45.92	$7,960	$95,510
Delaware	$41.42	$7,180	$86,150
Florida	$38.93	$6,750	$80,970
Georgia	$41.50	$7,190	$86,310
Hawaii	$55.15	$9,560	$114,720
Idaho	$38.29	$6,640	$79,650
Illinois	$40.05	$6,940	$83,310
Indiana	$36.82	$6,380	$76,580
Iowa	$33.79	$5,860	$70,290
Kansas	$35.07	$6,080	$72,950
Kentucky	$37.81	$6,550	$78,650
Louisiana	$36.99	$6,410	$76,930
Maine	$37.71	$6,540	$78,440
Maryland	$42.87	$7,430	$89,160
Massachusetts	$50.74	$8,790	$105,530
Michigan	$39.29	$6,810	$81,730
Minnesota	$43.29	$7,500	$90,040
Mississippi	$33.09	$5,740	$68,830
Missouri	$35.00	$6,070	$72,810
Montana	$38.17	$6,620	$79,390
Nebraska	$35.81	$6,210	$74,490
Nevada	$46.92	$8,130	$97,590
New Hampshire	$40.64	$7,040	$84,530
New Jersey	$47.09	$8,160	$97,950
New Mexico	$41.69	$7,230	$86,720
New York	$48.78	$8,460	$101,460
North Carolina	$37.72	$6,540	$78,450
North Dakota	$36.54	$6,330	$76,000
Ohio	$38.22	$6,620	$79,490
Oklahoma	$37.47	$6,500	$77,940
Oregon	$51.93	$9,000	$108,020
Pennsylvania	$39.28	$6,810	$81,700
Rhode Island	$42.99	$7,450	$89,420
South Carolina	$36.21	$6,280	$75,320
South Dakota	$31.42	$5,450	$65,360
Tennessee	$35.31	$6,120	$73,440
Texas	$41.08	$7,120	$85,440
Utah	$37.22	$6,450	$77,410
Vermont	$38.97	$6,750	$81,050
Virginia	$39.88	$6,910	$82,950
Washington	$49.53	$8,590	$103,020
West Virginia	$35.19	$6,100	$73,190
Wisconsin	$39.46	$6,840	$82,070
Wyoming	$39.46	$6,840	$82,080

Highest Paid Utilization Management Nurses in the Nation

What Are The 10 Highest Paying States For Utilization Management Nurses?

Now, let’s take a look at the highest paying states for utilization management nurses. California is the highest paying state, with paying an annual income of $135,110. Working in Hawaii will still have you earning six figures at $114,720 a year. Massachusetts, Oregon, and Alaska will have you making in the $105,000range. Washington, New York, Nevada, New Jersey, and Connecticut will have you earning a salary in the $90,000 range.

Rank	State	Average Annual Salary
1	California	$135,110
2	Hawaii	$114,720
3	Oregon	$108,020
4	Massachusetts	$105,530
5	Alaska	$104,680
6	Washington	$103,020
7	New York	$101,460
8	New Jersey	$97,950
9	Nevada	$97,590
10	Connecticut	$95,510

What Are The 10 Highest Paying Metros For Utilization Management Nurses?

So, we already know that California is the highest paying state for utilization management nurses. But let’s now take a look at the highest-paying metros for utilization management nurses. San Francisco-Oakland-Hayward, CA is the highest paying metro for utilization review nurses. Here you will be earning $166,950. Chico, CA, is the lowest paying metro out of the top ten highest paying metros for utilization nurses. Here you will still be earning six figures. Your salary will be $128,100.

Rank	Metro	Average Annual Salary
1	San Francisco-Oakland-Hayward, CA	$166,950
2	San Jose-Sunnyvale-Santa Clara, CA	$162,140
3	Vallejo-Fairfield, CA	$160,440
4	Santa Rosa, CA	$153,160
5	Santa Cruz-Watsonville, CA	$151,740
6	Napa, CA	$148,340
7	Sacramento--Roseville--Arden-Arcade, CA	$147,160
8	Modesto, CA	$140,350
9	Stockton-Lodi, CA	$132,100
10	Chico, CA	$128,100

Top Organizations and Associations for Utilization Management Nurses

• American Association of Managed Care Nurses: This organization provides its members with the education and resources needed to stay current in the field. Its mission is to be recognized as the expert in managed care as well as establish standards for the profession. This organization strives to affect policy surrounding managed care positively.

• American Nurses Association: The American Nurses Association is an organization that is basically the one-stop-shop for nurses. Here you will find articles on topics related to your practice and certification education. This site also is tailored to any of your advanced practice nurse needs.

My Final Thoughts

So, there you have it, the top 10 pros and cons of being a utilization management nurse + salary + steps to become one. So, is the grass greener on the other side? If you are still on the fence about whether or not to pursue this career, hopefully, our article has helped make your decision a little easier. Only you can decide. Suppose you are currently in a Utilization Management position or are considering making a career change. In that case, we hope these pros and cons of being a utilization management nurse have been helpful.

Frequently Asked Questions Answered by Our Expert

1. Is Utilization Management Nursing A Good Career?

Yes, being a Utilization management nurse is a promising career. Suppose you decide to pursue this career path. In that case, you will not only have an in-demand career but also earn an excellent salary. Being a utilization management nurse will mean stability for you and your family.

2. On Average, How Much Does A Utilization Management Nurse Make Per Hour?

The average utilization management nurse salary per hour is $43.36.

$43.36

3. How Many Hours A Week Does A Utilization Management Nurse Work?

As a utilization management nurse, you will find yourself working forty hours a week if you are a full-time employee. If you are a part-time employee, your hours will be less during the week. They will be somewhere around twenty hours a week.

4. Is Being A Utilization Management Nurse Stressful?

Being a Utilization management nurse can be stressful at times. Your stress will differ from other types of nurses, such as intensive care nurses. You will not be dealing with life and death. The pressure you feel will stem from deadlines and caseload.

5. Do I Need To Be Certified To Work As A Utilization Management Nurse?

Certification is not mandatory as a utilization management nurse, but it is strongly recommended. It will be very difficult to obtain and maintain a job without it.

6. What Certifications Are Required Or Recommended For A Utilization Management Nurse?

The two certifications you should consider pursuing are Health Care Quality and Management (HCQM) Board Certification and Health Utilization Management (HUM) Certifications. You can also attain earning certification as a Certified Case Management (CCM) certification. Basic Life support (BLS) may be required for some Utilization management nurse positions.

7. How Long Does It Take To Become A Utilization Management Nurse?

If you pursue earning your Associate's degree in nursing, then becoming a utilization management nurse should take about two years. If you choose the path of a bachelor's degree, then you are looking at four years.

8. How Much Does It Cost To Become A Utilization Management Nurse?

An associate's degree in nursing will cost anywhere from $6,000 to $150,000. If you choose to pursue a bachelor's degree in nursing, you will be spending anywhere from $20,000 - $200,000

9. What Kind Of Career Advancement Opportunities Are There For Utilization Management Nurses?

Suppose you want to advance your career as a utilization management nurse. In that case, you could consider earning a Masters's degree in administration. Earning this advanced degree will put you in the perfect position to become a manager.

You may also want to consider earning a master's in education. By earning a master's degree in education, you may be able to teach. You could end up teaching utilization review courses for certification. You can also teach continuing education courses for utilization management nurses.

10. What Are The 5 Most Common Utilization Management Nurse Interview Questions?

1. Where have you worked prior?
2. Why do you feel you are a good fit for this job?
3. Have you ever had to deal with angry patients or family members? If so, how did you handle it?
4. How would you handle stressful situations?
5. How do you prioritize your work when you need to juggle multiple tasks at once?

11. What Are 2 Of The Main Goals Of A Utilization Management Nurse?

There are two main goals of a utilization management nurse. These goals are how you will approach each and every case. These goals include:

1. To ensure the delivery of efficient and effective health care, to reduce the misuse of inpatient services.
2. To promote high-quality and safe patient care to the patient.

12. What Are The 3 Main Skills Required To Succeed As A Utilization Management Nurse?

1. Communication: You will need excellent communication skills to work as a utilization management nurse successfully. Strong communication skills are essential in this role, as utilization management nurses must effectively communicate with patients, families, physicians, and other healthcare team members. Utilization management nurses must also be able to clearly document patient care plans and communicate their recommendations to insurance companies.

2. Strong knowledge of word processing and spreadsheet computer programs: A Strong knowledge of word processing and spreadsheet computer programs is necessary to successfully work as a utilization management nurse. They also need to be able to keep accurate records and manage financial resources. Computer programs like Microsoft Word and Excel can help nurses in these roles keep track of essential data.

3. Time management: Time management is an important skill to have if you want to be successful in any field. But it is especially important if you're working as a utilization management nurse. Utilization management nurses are responsible for coordinating care and ensuring that patients receive the most appropriate level of care for their needs. This can be a very demanding job, and if you do not have good time management skills, it can be challenging to keep up with everything that needs to be done.

13. What Is The Difference Between Utilization Management Nurse And Utilization Review Nurse?

A utilization management nurse's job is similar to that of a utilization review nurse. The difference between these two positions lies within the time frame the work is completed. A utilization review nurse is a retrospective position. These nurses will review cases after healthcare services have been carried out. They will ensure that the proper care is given to the patient through proven methods, with the appropriate provider in the correct setting.

On the other hand, a utilization management nurse will focus on the strategies and policies that healthcare organizations put into place to help improve operating activities and ensure that patients receive an excellent quality of care. These nurses will ensure that the actions that are taken are in response to the utilization review results.

14. Is There A Demand For Utilization Management Nurse Work At Home Jobs?

Yes, there is a high demand for utilization management nurses working from home. Having a utilization management nurse work from home is a cost-effective way for companies to run their business. Employees who work from home are also more productive and happier.

15. What Is The Difference Between Utilization Management Specialist And Utilization Management Nurse?

Utilization management specialist does not have to be a nurse. A nurse can be accepted into the position of a utilization specialist, but so can those with other medical backgrounds, such as an EMT or a candidate with an experience in medical billing and coding. On the other hand, a Utilization management nurse must be a nurse.