Getting Started in Utilization Management: Tools, Trends, and Opportunities for RNs

Course Description

This course introduces registered nurses to the foundational principles of Utilization Management (UM), including Utilization Review (UR), evidence-based guidelines, payer-provider communication, and emerging industry trends. It is designed for nurses exploring non-clinical career paths and will explain how UM impacts cost-efficiency, care quality, and patient outcomes. Learners will gain clarity on how UM aligns with national health priorities and will explore potential roles, expectations, and next steps in this growing field.

Upon completion, participants earn 1 contact hour of continuing education, approved by the California Board of Registered Nursing (CEP18046).

Course Objectives

At the end of this course, the participant will be able to:

1. Define Utilization Management and distinguish it from Case Management.

2. Describe the three types of Utilization Review and their respective purposes.

3. Explain the role of MCG and InterQual guidelines in determining medical necessity.

4. Describe the nurse’s role in payer collaboration during concurrent review.

5. Analyze how Utilization Management supports national health priorities such as quality improvement, access to care, and cost containment.

Course Format & Learning Experience

• 💻 100% Online & Self-Paced – Learn at your convenience!
• 📚 Engaging Content – Real-world examples, interactive quiz, downloadable infographic.
• 📜 Certificate – Earn a certificate for 1 BRN-approved contact hour upon completion

Who Should Take This Course?

• Registered Nurses exploring Utilization Management careers
• Case Managers and Healthcare Professionals interested in UM
• Policy Makers evaluating nursing roles
• Anyone looking to understand UM and its role in healthcare

Course Pricing & Enrollment

•  Special Offer: Promotional pricing available for the first 10 registrants
• Standard Price: $15

📧 Questions? Contact Us: polina@medscholaria.com

Instructor Bio

Polina Obshchanska, BSN, RN – Lead Utilization Management Nurse, Continuing Education Provider, and MSN student in Nurse Administration. Polina has nearly 10 years of healthcare experience in hospice, case management, utilization management, and healthcare quality. She is the founder of Medscholaria Consulting, Inc., a BRN-approved CE provider dedicated to empowering nurses through relevant, timely, and nationally impactful education.

Refund & Cancellation Policy

Participants may request a full refund within 48 hours of enrollment. No refunds will be issued for incomplete or partially completed courses. Should Medscholaria Consulting, Inc. cancel the course, a full refund will be provided within 10 business days.

📜 BRN Provider Statement

Provider approved by the California Board of Registered Nursing, Provider Number CEP18046, for 1 contact hour.