Utilization review nurse

A utilization review nurse evaluates whether medical care is necessary, appropriate, and covered under a patient's insurance. They review clinical documentation and care plans against medical guidelines and payer criteria, approve or question requested services and hospital stays, communicate with providers, and help ensure patients get appropriate care while controlling unnecessary costs.

The role applies clinical knowledge to documentation and policy rather than direct patient care, requiring analytical skill and familiarity with insurance rules and medical criteria. These nurses work for insurance companies, hospitals, and review organizations, mostly at a desk.

The job suits experienced, detail-oriented nurses who want regular hours and analytical work away from the bedside.