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Utilization Review Terminology List
Intro to Utilization Review
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What is Utilization Review?
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History of UR
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Types of Utilization Review
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Service Types
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UR Nursing Process Timeline
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The Nurse’s Role in Prior Authorization
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Prior Authorization Flow Chart
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Prior Authorization Toolkit
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The Nurse’s Role in Concurrent Review
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Concurrent Review Toolkit
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The Nurse’s Role in Retrospective Review
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Retrospective Review Toolkit
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Utilization Review Scenarios for Nurses by UR Type
Utilization Review Nursing Process
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Determining Medical Necessity
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EBP Standard Guidelines
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EBP (Evidence-Based Practice) Conditions Required by Health Plans
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Understanding Medicare Guidelines, NCDs, and LCDs for Utilization Review Nurses
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Determining the Appropriate Practice Setting (How-To for UR Nurses)
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SI + IS Criteria Guidelines for Utilization Review Nurses
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Applying Severity of Illness (SI) + Intensity of Service (IS)
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Utilization Review Scenarios by Practice Setting
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Obtaining Peer-to-Peer Review
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Final Determination of Service (UR Nurse Decision-Making)
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Denial Reasons in Utilization Review
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Utilization Review Codes, Bundling, and Non-Approved Services
UR Test
Utilization Review vs Utilization Management
UR Nurse Career Development
UR Nurse Job List
Company Specific Interview Prep
