Top 12 Utilization Review Nurse Skills to Put on Your Resume
In a crowded healthcare arena, a sharp resume that spotlights the right skills can tilt the odds for utilization review nurses. The following skills drive efficient care decisions, guard resources, and keep patients moving through the system safely—and with fewer detours.
Utilization Review Nurse Skills
- InterQual
- Milliman
- Epic
- Cerner
- Case Management
- Medical Coding (ICD-10)
- Patient Advocacy
- Regulatory Compliance
- Clinical Documentation
- Quality Improvement
- Risk Management
- Telehealth Platforms
1. InterQual
InterQual provides evidence-based criteria that help determine the right level of care and appropriate settings. It anchors decisions to clinical facts and time-sensitive thresholds, not guesswork.
Why It's Important
It standardizes decisions around medical necessity and level of care, supporting fair, defensible approvals and denials while improving consistency across reviewers and settings.
How to Improve InterQual Skills
Regular training: Take refresher and advanced modules; focus on annual criteria updates and new pathways.
Practice scenarios: Run mock reviews across diverse diagnoses, including borderline cases that force nuanced interpretation.
Use the resources: Explore guides, release notes, and tip sheets; log tricky scenarios and build a personal reference library.
Peer calibration: Hold case huddles to compare rationales and tighten inter-rater reliability.
Feedback loops: Review overturns and appeals data; track where your criteria application can be sharper.
Mastery shows in faster, cleaner determinations with fewer avoidable escalations.
How to Display InterQual Skills on Your Resume
2. Milliman
In many organizations, “Milliman” is shorthand for MCG criteria (formerly Milliman Care Guidelines). These evidence-based guidelines support level-of-care, length-of-stay, and medical necessity determinations across inpatient and outpatient settings.
Why It's Important
Clear, current criteria reduce variation and strengthen determinations. They also streamline payer conversations, shortening the distance between review and resolution.
How to Improve Milliman Skills
Know the books: Stay current with MCG updates, including care guidelines, recovery facilities, and ambulatory care chapters.
Refine clinical judgment: Pair guideline criteria with clinical nuance—vitals, response to treatment, trajectory—so the decision fits the patient, not just the page.
Document the “why”: Capture the exact criteria met or not met, plus the clinical context, to fortify determinations.
Case reviews with peers: Audit complex denials and overturned cases to sharpen interpretation and reduce rework.
Technology fluency: Use embedded MCG tools, flags, and pathways inside your EHR or utilization platforms to cut clicks and errors.
How to Display Milliman Skills on Your Resume
3. Epic
Epic is a full-spectrum EHR that connects orders, notes, results, and care coordination in one place. For utilization review nurses, it’s the cockpit: data in, decisions out, communication flowing.
Why It's Important
Real-time visibility into charts, timelines, and utilization dashboards supports faster, evidence-backed decisions and clearer care transitions.
How to Improve Epic Skills
Customize SmartPhrases and SmartTexts: Build templates that mirror your review workflow and criteria language.
Use Reporting Workbench: Track daily work queues, LOS outliers, and pending authorizations; turn data into action.
Streamline InBasket: Triage with filters and quick actions so high-impact messages surface first.
Best Practice Advisories: Collaborate with IT to tune alerts that matter to UR—status changes, escalations, avoidable delays.
Training sprints: Short, frequent refreshers on new features beat once-a-year marathons.
Tighten handoffs: Use Care Team tools and handoff notes to keep continuum partners aligned.
How to Display Epic Skills on Your Resume
4. Cerner
Cerner (now part of Oracle Health) delivers EHR tools that stitch clinical data, orders, and documentation into a single record. UR nurses rely on that record to validate medical necessity and level of care cleanly.
Why It's Important
Accurate, timely data—labs, imaging, notes, orders—reduces ambiguity and shortens the path from chart review to determination.
How to Improve Cerner Skills
Workflow tailoring: Configure UR-specific views, filters, and favorites so the critical details land front and center.
Focused training: Deep-dive into documentation, status changes, and reporting features you actually use.
Decision support: Leverage embedded clinical decision support for admission status and criteria prompts.
Actionable alerts: Build alerts for milestones—peer-to-peer deadlines, expiring auths, readiness for discharge.
Collaboration tools: Use secure messaging and team spaces to align with case management and provider teams in real time.
Analytics: Pull quick reports on LOS, denials, and secondary reviews to spot friction and fix it.
How to Display Cerner Skills on Your Resume
5. Case Management
Case management orchestrates services and transitions so patients get the right care, at the right time, in the right place. UR nurses partner closely with case managers to connect decisions to action.
Why It's Important
It reduces delays, prevents unnecessary days, and centers the plan of care around what the patient actually needs—clinically and socially.
How to Improve Case Management Skills
Keep learning: Refresh knowledge on payer policies, post-acute criteria, and community resources.
Tech that helps: Use case management platforms and EHR workflows that track barriers, authorizations, and disposition in one view.
Say it clearly: Hone concise, assertive communication with providers, payers, and families.
Time discipline: Prioritize high-impact cases and hard deadlines; batch the rest.
Legal and ethical grounding: Know consent, privacy, and patient rights cold.
Interdisciplinary rhythm: Daily rounds with medicine, therapy, and social work reduce surprises.
Advocacy mindset: Align dispositions with goals of care, not just availability.
How to Display Case Management Skills on Your Resume
6. Medical Coding (ICD-10)
ICD-10-CM/PCS translates conditions and procedures into standardized codes. For UR nurses, it’s the language that binds documentation, criteria, and reimbursement together.
Why It's Important
Accurate coding supports medical necessity decisions, risk adjustment, and clean claims. Precision here prevents denials later.
How to Improve Medical Coding (ICD-10) Skills
Update annually: Review yearly ICD-10-CM/PCS changes and guideline revisions; pay attention to laterality, combination codes, and specificity rules.
Pair code with clinical: Validate that documented clinical indicators support the code selections—no gaps, no leaps.
Use coding tools: Reference encoders and codebooks to check excludes notes, sequencing, and inclusion terms.
Audit and learn: Spot recurring misses—sepsis, AKI stages, heart failure types—and coach for clarity in documentation.
Practice reps: Work sample cases and compare with coding teams to align interpretations.
How to Display Medical Coding (ICD-10) Skills on Your Resume
7. Patient Advocacy
Advocacy means safeguarding access to the right care and pushing through obstacles—policy, process, or payer—so patients aren’t stranded.
Why It's Important
It protects patient rights, reduces inequities, and translates clinical need into authorized services without avoidable delay.
How to Improve Patient Advocacy Skills
Communication that lands: Use plain language with patients and crisp clinical language with payers; both matter.
Goal-concordant care: Anchor plans to patient values and preferences, then document them.
Know the rules: Stay current on coverage policies, appeals pathways, and grievance processes.
Negotiate gracefully: Build a clear case with facts, alternatives, and risk tradeoffs; keep emotions cool and purposeful.
Leverage tech: Use portals and secure messaging to close loops quickly and keep patients in the know.
How to Display Patient Advocacy Skills on Your Resume
8. Regulatory Compliance
Compliance means aligning practice with laws, accreditation standards, payer rules, and internal policies—without shortcuts.
Why It's Important
It shields patients and organizations from risk: legal, financial, and reputational. It also yields reliable, repeatable processes.
How to Improve Regulatory Compliance Skills
Structured updates: Track changes in federal, state, payer, and accreditation requirements on a set cadence.
Written plan: Maintain clear policies, procedures, and internal controls for UR activities and documentation.
Audit routinely: Perform focused audits on authorizations, status changes, and LOS outliers; remediate fast.
Teach the “why”: Build a culture where staff raise concerns early and understand the reason behind the rule.
Document decisively: If it isn’t documented, it didn’t happen—capture criteria, rationale, and timelines.
How to Display Regulatory Compliance Skills on Your Resume
9. Clinical Documentation
Documentation is the official record of what happened, why it happened, and how the patient responded. It’s the backbone of any medical necessity argument.
Why It's Important
Clean, specific notes support coding, level-of-care decisions, and safe handoffs. Vague documentation invites denials and delays.
How to Improve Clinical Documentation Skills
Standards and specifics: Push for diagnoses with stage, type, acuity, and etiology; avoid nonspecific placeholders.
EHR tools: Use templates, prompts, and problem lists to reduce omissions.
Concurrent review: Clarify in real time—query providers promptly when criteria aren’t fully supported.
Regular audits: Review charts for completeness and consistency; close gaps with targeted coaching.
Interdisciplinary sync: Align notes across nursing, medicine, therapy, and case management so the story matches.
How to Display Clinical Documentation Skills on Your Resume
10. Quality Improvement
QI is the disciplined hunt for better outcomes and smoother processes—measure, test, learn, repeat.
Why It's Important
It trims waste, lifts safety, and channels resources to where they matter most. Small fixes compound into big gains.
How to Improve Quality Improvement Skills
Data first: Track metrics that move the needle—avoidable days, denial rates, time-to-authorization, readmissions.
SMART aims: Set crisp goals with timelines and owners; ambiguity is the enemy.
PDSA cycles: Test changes on a small scale, learn quickly, then scale what works.
Evidence-based moves: Bring guidelines and proven interventions to the frontline.
Team sport: Involve bedside staff, physicians, and revenue cycle partners so improvements stick.
How to Display Quality Improvement Skills on Your Resume
11. Risk Management
Risk management spots trouble before it bites—clinical, operational, or financial—and builds guardrails to keep patients safe and organizations steady.
Why It's Important
Better risk practices reduce harm, cut liability, and improve the reliability of care delivery. Fewer surprises, fewer crises.
How to Improve Risk Management Skills
Know the regs: Keep pace with payer rules, conditions of participation, and state requirements.
Communicate precisely: Document facts, escalation steps, and time stamps; be unambiguous.
Use checklists and tools: Standardize reviews for high-risk diagnoses, procedures, and transitions.
Education that sticks: Short scenario-based drills beat long lectures; practice the tough calls.
Build protocols: Standard work for status changes, peer-to-peer reviews, and appeals reduces variation.
Professional networks: Share lessons learned and benchmark your outcomes against peers.
How to Display Risk Management Skills on Your Resume
12. Telehealth Platforms
Telehealth tools enable virtual visits, remote monitoring, and rapid follow-up. UR nurses use them to validate progress and reduce avoidable inpatient days.
Why It's Important
It expands access, speeds decision-making, and keeps care moving without waiting for a physical room. Continuity without friction.
How to Improve Telehealth Platforms Skills
Integrate with EHR: Ensure data flows both ways—notes, vitals, orders—so nothing gets siloed.
Security first: Enforce HIPAA-compliant workflows, multi-factor authentication, and consent capture.
Simple UX: Choose interfaces that patients and clinicians can navigate without a manual.
Training and support: Offer brief how-tos, quick guides, and live help for common snags.
Feedback channels: Collect input from users routinely and iterate on what slows them down.
How to Display Telehealth Platforms Skills on Your Resume
