Top 11 Utilization Review Nurse Certifications

Certifications for utilization review nurses are important in the job market because they demonstrate to employers that the nurse has achieved a certain level of knowledge and expertise. Certifications also give employers assurance that the nurse is up-to-date on the latest standards, regulations, and best practices in utilization review. This helps ensure that their organization is compliant with all aspects of healthcare delivery. Furthermore, certifications can help open up more career opportunities and higher salaries. In addition, certifications provide the nurse with credibility and recognition when seeking new positions or promotions within an organization.

This article reviews some of the top certifications for Utilization Review Nurses and explains how they can help advance an utilization review nurse's career.

What are Utilization Review Nurse Certifications?

Utilization review nurse certification is a certification that provides healthcare professionals with the knowledge and skills necessary to work in the field of utilization review. Utilization review is a process for evaluating and approving the medical necessity, appropriateness, and efficiency of health care treatments or services. It ensures that medically necessary services are provided in a cost-effective manner, while also protecting patients from receiving unnecessary or inappropriate services.

Utilization review nurse certification can help nurses to become qualified to assess patient records and determine if the requested treatments are appropriate and necessary, as well as if they are being provided according to accepted standards of practice. This helps ensure that patients receive the best possible care while also helping providers to control costs. Additionally, this certification allows nurses to demonstrate their expertise and increase their value in the job market.

Pro Tip: Utilization review nurse certification can help you stand out from the competition and demonstrate your commitment to quality patient care. Make sure to research different certifications and choose one that best suits your career goals. Additionally, take advantage of study materials and online courses to ensure you have a thorough understanding of the certification requirements.

Related: What does an Utilization Review Nurse do?

Top 11 Utilization Review Nurse Certifications

Here’s our list of the best certifications available to Utilization Review Nurses today.

1. Certified Professional Utilization Review Nurse (CPURN)

A Certified Professional Utilization Review Nurse (CPURN) is a nurse who has been certified by the American Nurses Credentialing Center (ANCC) to review and evaluate the medical necessity, appropriateness, and efficiency of health care services. CPURNs are responsible for ensuring that health care services are provided in accordance with established standards of practice and applicable laws. They also provide guidance to providers on how to improve the quality of care they deliver.

To become a CPURN, you must first have an active Registered Nurse (RN) license from your state board of nursing and have at least two years of clinical experience in utilization review or case management. You must then pass the ANCC's certification exam, which covers topics such as patient rights, reimbursement systems, regulatory compliance, and quality improvement initiatives. The exam consists of 175 multiple-choice questions and takes about three hours to complete.

The cost for taking the exam is $350 for members of the American Nurses Association or $400 for non-members. After passing the exam, you will be awarded your CPURN credential and will need to renew it every five years by completing continuing education activities or retaking the certification exam.

2. Certified Case Manager (CCM)

Certified Case Manager (CCM) is a professional certification offered by the Commission for Case Manager Certification (CCMC). It is designed to recognize individuals who possess the knowledge, skills, and abilities necessary to provide quality case management services.

The CCM certification is based on the Core Competencies for Case Management Practice, which are the foundation of case management practice. To become certified, an individual must pass a comprehensive examination that covers all of the core competencies. The exam consists of 150 multiple-choice questions and takes approximately three hours to complete.

To receive the CCM certification, an individual must meet certain eligibility requirements and submit an application to the CCMC. Eligibility requirements include having a bachelor’s degree in any field from an accredited college or university; having at least two years of full-time experience as a case manager; and being currently employed in a case management role or having been employed in such a role within the past two years.

The cost of obtaining the CCM certification varies depending on when you apply and how you pay for it. The application fee is $350 USD, but there may be additional fees associated with late applications or payment by credit card. Additionally, there are costs associated with taking and passing the exam, including registration fees and study materials.

3. American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)

The American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) is a professional organization that certifies physicians in the field of quality assurance and utilization review. ABQAURP provides certification for physicians who specialize in evaluating the quality and appropriateness of health care services. This certification helps ensure that patients receive safe, effective, and appropriate medical care.

In order to become certified by ABQAURP, physicians must have a minimum of three years of post-graduate experience in an accredited residency program and must pass a comprehensive exam. The exam covers topics such as quality assurance principles, utilization review processes, healthcare regulations, and patient safety.

The process for becoming certified by ABQAURP typically takes about six months from start to finish. To begin the process, applicants must submit an application form along with the required documentation (such as transcripts from medical school). Once the application is approved, applicants can register for the exam which is offered twice per year (in June and December). The cost of the exam is $1,000 USD. After passing the exam, applicants will receive their certificate within two weeks.

Overall, obtaining certification through ABQAURP can be a lengthy process but it is well worth it for those looking to specialize in quality assurance and utilization review.

4. Certified Utilization Management Coordinator (CUMC)

Certified Utilization Management Coordinator (CUMC) is a certification that recognizes individuals who have achieved a high level of expertise in the utilization management field. Utilization management is the process of managing the use of health care services and resources to ensure they are provided in an effective, efficient, and cost-effective manner. CUMCs are responsible for assessing and evaluating patient care requests, developing utilization management plans, providing education and support to providers, and coordinating with other departments within the health care organization.

It typically takes between six months to one year to complete all requirements for the CUMC certification. Requirements include completing an approved utilization management program or coursework, passing a written exam administered by the National Association of Utilization Management Professionals (NAUMP), and meeting experience requirements as outlined by NAUMP.

The cost of obtaining the CUMC certification varies depending on whether you choose to take a course or program from an accredited institution or self-study with NAUMP materials. Generally speaking, courses from accredited institutions can range from $500 - $2,000 while self-studying with NAUMP materials can range from $400 - $1,000.

In addition to these costs, there may also be fees associated with taking the exam as well as annual renewal fees for maintaining your certification status.

5. Certified Utilization Management Executive (CUME)

Certified Utilization Management Executive (CUME) is a professional certification offered by the American Association of Managed Care Nurses (AAMCN). The CUME credential recognizes professionals who have demonstrated expertise in utilization management, which is a process used to ensure that healthcare services are medically necessary, cost-effective, and of the highest quality.

The CUME certification requires applicants to have a minimum of three years' experience in utilization management and pass an examination. Applicants must also complete a continuing education program every two years to maintain their certification.

To obtain the CUME certification, applicants must submit an application form and fee to AAMCN. The fee for the CUME exam is $350 for members and $400 for non-members. Once the application has been approved, applicants will receive instructions on how to register for the exam. The exam consists of 150 multiple choice questions and takes approximately four hours to complete.

The cost of obtaining the CUME credential varies depending on whether or not you are an AAMCN member. For members, it costs $350 for the exam plus any additional fees associated with completing continuing education requirements every two years. For non-members, it costs $400 for the exam plus any additional fees associated with completing continuing education requirements every two years.

6. Certified Managed Care Professional (CMCP)

Certified Managed Care Professional (CMCP) is a professional certification program designed to recognize and promote the knowledge and skills of individuals who work in managed care organizations. The program is administered by the National Committee for Quality Assurance (NCQA), an independent, not-for-profit organization that sets standards for health care quality.

To be eligible for the CMCP credential, applicants must have at least two years of full-time experience working in managed care or related fields. They must also pass an exam covering topics such as healthcare finance, provider contracting, regulatory compliance, and quality improvement.

The exam is offered twice a year in April and October. It takes about three hours to complete and consists of 150 multiple-choice questions. The cost of taking the exam is $450 ($350 for NCQA members). After passing the exam, applicants are awarded the CMCP credential which is valid for three years before it needs to be renewed.

7. American Nurses Credentialing Center (ANCC) – Utilization Management Nursing Certification

The American Nurses Credentialing Center (ANCC) Utilization Management Nursing Certification is a specialty certification for nurses who are involved in utilization management. It is designed to recognize the knowledge and skill of nurses who are responsible for assessing, planning, implementing, and evaluating the use of health care resources.

To be eligible for this certification, an individual must have a current RN license and at least two years of full-time work experience in utilization management or related fields. The exam consists of 175 multiple-choice questions covering topics such as healthcare systems, clinical practice guidelines, resource management principles, and reimbursement policies.

The exam takes approximately four hours to complete and the cost is $360 for ANCC members and $460 for non-members. To get certified, individuals must pass the exam with a score of at least 70%. Once certified, individuals must renew their credential every five years by completing continuing education credits or retaking the exam.

8. National Association of Managed Care Nurses – Managed Care Nursing Certification

The National Association of Managed Care Nurses (NAMCN) is a professional organization dedicated to advancing the practice of managed care nursing. The NAMCN offers a Managed Care Nursing Certification, which is designed to recognize nurses who have demonstrated knowledge and expertise in managed care nursing.

To be eligible for the certification, applicants must hold an active RN license and have at least two years of experience in managed care nursing. They must also complete 15 continuing education credits related to managed care within the past three years.

The certification exam consists of multiple-choice questions covering topics such as health plan management, utilization management, quality assurance, case management, and population health management. It takes approximately three hours to complete the exam.

The cost for the certification exam is $395 for NAMCN members and $495 for non-members. Additional fees may apply if you need to retake the exam or if you need to renew your certification every five years.

9. National Alliance of Healthcare Purchasing Professionals – Health Care Purchasing Certification

The National Alliance of Healthcare Purchasing Professionals (NAHPP) is a professional organization that provides education and certification for healthcare purchasing professionals. The NAHPP Health Care Purchasing Certification is the only nationally recognized certification program for healthcare purchasing professionals.

The certification process consists of two parts: an online assessment and a comprehensive exam. The online assessment consists of multiple-choice questions that test the candidate’s knowledge of healthcare purchasing principles, processes, and practices. Upon successful completion of the assessment, candidates can then take the comprehensive exam which tests their ability to apply their knowledge in real-world scenarios.

It typically takes about three months to complete the certification process, depending on how quickly you work through the material and complete the exams. To get certified, you must first become a member of NAHPP and then register for the certification program. Once registered, you will receive access to all necessary materials and resources needed to complete your studies and exams.

The cost for NAHPP members is $250 USD for both parts of the certification process (assessment and exam). Non-members are required to pay an additional $50 USD fee when registering for the program.

10. American Academy of Professional Coders – Medical Coding and Billing Certification

The American Academy of Professional Coders (AAPC) Medical Coding and Billing Certification is a professional certification for medical coding and billing professionals. It is designed to demonstrate mastery of the skills needed to accurately code and bill for medical services.

It typically takes about 6-9 months to complete the AAPC Medical Coding and Billing Certification. The time frame depends on how quickly you can study and take the exam, as well as any other commitments you may have. To get certified, you must first pass the AAPC Medical Coding and Billing Exam. This exam consists of 150 multiple choice questions that assess your knowledge of medical terminology, anatomy, physiology, diagnosis coding, procedure coding, reimbursement methodologies, compliance guidelines, healthcare information systems, and medical billing processes.

The cost of the AAPC Medical Coding and Billing Certification varies depending on your membership status with the organization. If you are an AAPC member in good standing, then you will pay $399 for the exam fee plus any applicable taxes. Non-members will pay $499 plus any applicable taxes. In addition to these fees there are also additional fees for study materials such as books or online courses which can range from $50-$200 depending on what type of material you choose to purchase.

Once you have passed the exam, you will receive your certification within 4-6 weeks after completing all requirements. You will also be eligible to apply for jobs that require this certification or use it as a credential when applying for higher positions within healthcare organizations.

11. Commission for Case Manager Certification – Certified Case Manager-Certified Utilization Review Nurse Dual Certification

The Commission for Case Manager Certification (CCMC) offers a dual certification for case managers and utilization review nurses. This dual certification is designed to recognize the unique skills and knowledge required of both roles, and to help ensure that case managers and utilization review nurses have the competencies necessary to provide quality care.

It typically takes about six months to complete the process of obtaining the CCMC dual certification. The first step is to obtain your initial certification as either a Certified Case Manager (CCM) or a Certified Utilization Review Nurse (CURN). Once you have obtained your initial certification, you can apply for the dual certification by submitting an application, providing proof of your initial certification, and paying the applicable fees.

The cost of obtaining the CCMC dual certification varies depending on which certifications you are seeking. The cost for both CCM and CURN certifications is $395 each, plus applicable taxes. Additionally, there may be additional fees associated with recertification every five years.

Overall, obtaining the CCMC dual certification requires dedication and commitment in order to successfully complete all requirements within six months. However, having this credential demonstrates a high level of expertise in both case management and utilization review nursing, which can lead to increased job opportunities in healthcare organizations.

Do You Really Need a Utilization Review Nurse Certificate?

The short answer is no. You do not need an Utilization Review Nurse Certificate to practice as a nurse in the United States. The certificate is a voluntary credential that demonstrates a specialty knowledge and skill set related to utilization review, a process by which health care providers assess the appropriateness of health care services for patients.

The certificate can be beneficial for nurses who want to specialize in utilization review, as it serves as an indication of expertise within this area. It also may give nurses an edge when seeking employment or promotions in organizations that value utilization review expertise. Additionally, some employers may require the credential for certain positions involving utilization review activities.

However, there are other ways to demonstrate proficiency in utilization review without obtaining the certificate. For instance, nurses can take classes related to utilization review at accredited universities or colleges, participate in continuing education courses related to utilization review, and read professional literature on the topic. Additionally, many employers offer on-the-job training and mentoring programs specific to utilization review processes.

Ultimately, whether or not you should pursue an Utilization Review Nurse Certificate depends on your goals and situation. If you have access to educational resources related to utilization review and/or have employer support for pursuing the certificate, then it could be worth considering. However, if you do not feel that obtaining the certification will be beneficial for your career path or current job prospects then it may not be necessary for you to pursue the credential at this time.

Related: Utilization Review Nurse Resume Examples

FAQs About Utilization Review Nurse Certifications

1. What qualifications are required to become a Utilization Review Nurse?

Answer: A Utilization Review Nurse must have a valid RN license, a Bachelor’s degree in Nursing, and have at least two years of experience in utilization review.

2. How long does it take to become certified as a Utilization Review Nurse?

Answer: It typically takes between 6-12 months to complete the certification process.

3. What is the cost of obtaining a Utilization Review Nurse certification?

Answer: The cost of obtaining a Utilization Review Nurse certification varies depending on the certifying organization but generally costs between $300-$500.

4. What continuing education requirements must be met to maintain my Utilization Review Nurse certification?

Answer: To maintain your certification, you must complete continuing education credits every two years, which vary depending on the certifying organization.

5. Are there any professional organizations for Utilization Review Nurses that offer resources and support?

Answer: Yes, there are several professional organizations for Utilization Review Nurses such as the American Association of Managed Care Nurses (AAMCN), National Association for Healthcare Quality (NAHQ), and American Organization of Nurse Executives (AONE). These organizations offer resources, networking opportunities, and support for Utilization Review Nurses.