Utilization Review Nurse Resume Examples & Tips for 2025

As a Utilization Review Nurse, you will evaluate medical necessity, review treatment plans, and ensure appropriate healthcare resource allocation while serving as a critical liaison between healthcare providers, insurance companies, and patients. This role requires an active RN license, 3+ years of clinical experience, strong analytical skills, and in-depth knowledge of healthcare regulations, medical coding, and insurance guidelines. The position plays a vital role in optimizing patient care outcomes while managing healthcare costs, ensuring compliance with regulatory requirements, and maintaining quality standards across the healthcare delivery system.