Are there utilization review certification courses?

[Nurse Beth, MSN]

Hi Nurse Beth,

I am an RN with 30 years experience in acute medical, respiratory, geriatrics, psych and developmental disabilities.

Are there any courses to take for utilization review to become certified as a UR nurse?

Thanks.

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Dear Wants UR Certification

Utilization review is a great job in many ways for a nurse like yourself with years of nursing experience. No weekends, holidays or night shifts! You can work in different settings, including hospitals and insurance companies.

As a UR nurse, you learn and apply the standard criteria insurance companies use to approve or deny treatment such as DME, level of medical intensity, and so on. You work with treating providers and managed care nurses to make sure patients receive care that is cost effective and evidence-based.

Resources

Another role to consider is case management or telephonic case management. Check out the Case Management Society of America (CMSA).

You can learn a lot on the Utilization Review Accreditation Commission (URAC) website. They offer educational events and post the qualifications for related jobs.

You can check out or join the American Association of Managed Care Nurses (AAMCN). AAMCN also has a Facebook page.

Certification

The American Nurses Credentialing Center (ANCC) offers a Nursing Case Management certificate, but the eligibility requirements include a minimum of 2,000 hours of clinical practice in nursing case management within the last 3 years.

The Commission for CCMC offers the CCM certification, and the eligibility requirements are at least 12 months case management experience.

The American Board of Managed Care Nursing (ABMCN) also offers a certification in managed care nursing (CMNC).

Most all certifications do require clinical time in the area of speciality before you are eligible to apply for the certification exam. Once you're in the field, you can find out what your colleagues say is the most useful certification.

Be sure and read the Nursing Specialty Case Management Forum here on allnurses to learn more.

Best wishes,

Nurse Beth