Experts in the field.

Course instruction is provided by nurses with at least 10 years of working knowledge in their field of expertise.

Easy to Comprehend

Courses are developed with key concepts that adult learners can easily understand and put to practice.

Provides CE Hours

Elevate your professional credentials with courses that contribute towards your license renewal Continuing Education requirements.

Step Off the Floor.  Step Into Your Future.

Nursing shouldn’t mean choosing between burnout and stagnation. If you're feeling the weight of the bedside, struggling to transition into Utilization Management, or frustrated by the lack of real-world training on UM principles—you're not alone. And more importantly, there's a path forward. This Utilization Management in Nursing course was designed for nurses, by experts who understand what it takes to make the leap. Learn practical UM concepts, develop the skills hiring managers are looking for, and turn your clinical experience into a strategic advantage. ✅ Tackle burnout by redefining your career path  ✅ Bridge the gap with comprehensive, nurse-friendly UM training  ✅ Earn continuing education (CE) hours that count toward license renewal Your skills are valuable. This course proves it. Enroll now and take that first step into a more sustainable, purpose-driven nursing future.

Meet Nurse Tan

Embark on a voyage with Nurse Tan, a seasoned Registered Nurse boasting 17 years in healthcare. Through her mastery of Instructional Design and Adult Learning, she crafts interactive courses that elevate nurses to new heights in their profession.

Curriculum

8 Chapters · 54 Lessons

  1. 1

    Introduction to Utilization Management (UM)

    1. (Included in full purchase)

      Intro to Module 1

    2. (Included in full purchase)

      Definition and Purpose of Utilization Management (UM

    3. (Included in full purchase)

      Importance of Utilization Management in Nursing Practice:

    4. (Included in full purchase)

      Role of Nurses in Utilization Management

  2. 2

    Key Components of Utilization Management

    1. (Included in full purchase)

      Intro to Module 2

    2. (Included in full purchase)

      Preauthorization and Medical Necessity Reviews

    3. (Included in full purchase)

      Preauthorization and Medical Necessity Reviews cont.

    4. (Included in full purchase)

      Preauthorization and Medical Necessity Reviews cont.

    5. (Included in full purchase)

      Preauthorization Review Example

    6. (Included in full purchase)

      Concurrent Review Example

    7. (Included in full purchase)

      Retrospective Review Example

    8. (Included in full purchase)

      Case Management Example

    9. (Included in full purchase)

      Care Coordination Example

  3. 3

    Regulatory and Compliance Considerations

    1. (Included in full purchase)

      Intro to Module 3

    2. (Included in full purchase)

      CMS Guidelines and Insurance Regulations in UM

    3. (Included in full purchase)

      CMS Guideline and Insurance Regulations cont

    4. (Included in full purchase)

      CMS Guidelines and Insurance Regulations cont

    5. (Included in full purchase)

      HIPAA and Patient Privacy in Utilization Management

    6. (Included in full purchase)

      HIPAA and Patient Privacy in Utilization Management cont

    7. (Included in full purchase)

      HIPAA and Patient Privacy in Utilization Management cont

    8. (Included in full purchase)

      Ethical Considerations in Utilization Management

    9. (Included in full purchase)

      Ethical Considerations in Utilization Management cont

    10. (Included in full purchase)

      Ethical Considerations in Utilization Management cont

  4. 4

    Utilization Review Process

    1. (Included in full purchase)

      Intro to Module 4

    2. (Included in full purchase)

      Criteria for Medical Necessity (e.g., InterQual, Milliman Guidelines)

    3. (Included in full purchase)

      Application of criteria in UM

    4. (Included in full purchase)

      Documentation Requirements for the Utilization Review process

    5. (Included in full purchase)

      UM Best Practices

    6. (Included in full purchase)

      Appeals and Denials

    7. (Included in full purchase)

      Strategies for Successful Appeals

  5. 5

    Impact of Utilization Management on Patient Care

    1. (Included in full purchase)

      Intro to Module 5

    2. (Included in full purchase)

      Ensuring Quality of Care while Managing Costs

    3. (Included in full purchase)

      A Real world example of UM in action

    4. (Included in full purchase)

      Ensure Quality of Care While Managing Costs

    5. (Included in full purchase)

      A Real world example of UM in action

    6. (Included in full purchase)

      Barriers and Challenges in UM Implementation

    7. (Included in full purchase)

      Barriers and Challenges in UM Implementation cont.

    8. (Included in full purchase)

      Barriers and Challenges in UM Implementation cont

    9. (Included in full purchase)

      Barriers and Challenges in UM Implementation cont

    10. (Included in full purchase)

      A Real world example of UM in action

  6. 6

    Nurse’s Role in Utilization Management

    1. (Included in full purchase)

      Intro to Module 6

    2. (Included in full purchase)

      Nurse’s Role in Utilization Management

    3. (Included in full purchase)

      Case Study # 1

    4. (Included in full purchase)

      Case Study # 2

    5. (Included in full purchase)

      Case Study # 3

    6. (Included in full purchase)

      Communication with Healthcare Teams & Insurers

    7. (Included in full purchase)

      Communication with Healthcare Teams & Insurers cont

    8. (Included in full purchase)

      Advocacy for Patients in UM Decisions

  7. 7

    Best Practices and Future Trends

    1. (Included in full purchase)

      Intro to Module 7

    2. (Included in full purchase)

      Emerging Technologies in Utilization Management

    3. (Included in full purchase)

      Emerging Technologies in Utilization Management cont

    4. (Included in full purchase)

      Strategies for Improving UM Efficiency

    5. (Included in full purchase)

      Professional Development Opportunities in UM

  8. 8

    Assessment

    1. (Included in full purchase)

      Utilization Management in Nursing

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You Became a Nurse to Care. Not to Burn Out.

It's time to choose yourself without choosing out of nursing. Next Level Nurse Pro is your all-access pass to a healthier, more sustainable future in care. With a low-cost membership, you’ll unlock: ✅ Unlimited access to Next Level courses designed to help you reclaim your strength—mind, body, and career  ✅ Discounted learning that fits into your life and your goals  ✅ Engaging training that’s CE Broker approved and counts toward your nursing license renewal  ✅ Member-only direct access to job postings and recruiters who value your expertise  ✅ Exclusive insider opportunities to pivot into roles that support your health while still making an impact You’ve given everything to your patients. Now it’s your turn. Join Next Level Nurse Pro's Platinum Membership today and invest in a future that rewards your dedication—without draining your energy.

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