After more than 100 applications and being told she needed experience, Jill found a way to break into utilization review.

Jill Connolly, BSN, RN, knew she was ready for a change.

She had years of acute care nursing experience, including medical-surgical, progressive care, and observation nursing. She enjoyed bedside nursing, but living in Michigan’s Upper Peninsula meant at least a 45-minute commute each way.

Jill had previously worked remotely as a medical transcriptionist and valued the flexibility of working from home. When a nurse she knew transitioned from bedside nursing into utilization management, Jill began to see another possibility for her own career.

The role made sense to her. It combined clinical knowledge, critical thinking, and nursing judgment without requiring her to remain at the bedside.

But knowing what she wanted to do and getting hired to do it were two very different things.

The Challenge: Breaking Into Utilization Review Without Experience

Jill faced the same obstacle many nurses encounter when trying to transition into utilization review: employers wanted prior UR experience.

Her situation presented additional challenges. Her acute care experience was no longer as recent as many employers preferred, and she also had an extended employment gap. At the time she was applying, Michigan was not part of the Nurse Licensure Compact, which further limited the remote nursing opportunities available to her.

Jill knew she needed to find a way to make herself a stronger candidate.

The Plan: Build Utilization Management Skills and Learn MCG

Before beginning her job search, Jill researched the best path for transitioning into utilization management and found Case Management Institute.

She enrolled in CMI’s Utilization Management and MCG Fundamentals course.

The course gave her a foundation in utilization management, insurance concepts, Medicare, medical necessity, and the UM process. She also gained hands-on experience using MCG Care Guidelines.

After successfully completing the training, Jill became eligible to sit for MCG certification and earned her MCG Care Guidelines Specialist – ISC/GRC certification.

That gave Jill something she had not had before: a way to demonstrate to employers that, although she had not yet worked in UR, she understood the UR/UM process, had hands-on experience using MCG, and had earned MCG certification.

Then she began applying.

The Job Search: More Than 100 Applications

Even with her preparation, breaking into utilization review was not easy.

Jill applied to more than 100 positions and landed only a handful of interviews.

But her preparation was getting noticed.

“Every interviewer specifically credited the MCG certification with getting me in the door.”

The biggest obstacle remained her lack of direct UR experience.

As the job search continued, Jill reached back out to CMI for guidance. Deanna Cooper Gillingham, RN, CCM, FCM, helped her identify some of the barriers she was facing, offered practical suggestions for strengthening her job search, and encouraged her not to give up.

Jill took the advice and kept going.

She continued applying, learning, and looking for an employer willing to give an experienced bedside nurse the opportunity to transition into utilization review.

The Opportunity: A Path From Bedside Nursing to Utilization Review

Eventually, Jill was contacted about a pilot program being staffed for a health plan.

The program was designed to train experienced bedside nurses to transition into utilization management.

Jill’s years of acute care experience gave her the clinical foundation the employer was looking for. But she also came into the interview with an advantage.

She was already familiar with utilization management and MCG.

Through Utilization Management and MCG Fundamentals, she had learned the UM process, worked directly with MCG Care Guidelines, and earned her MCG certification.

According to Jill, that preparation helped her stand out.

“The interviewers were impressed that I was already familiar with MCG. The training I received with CMI helped make me a standout for this position.”

Only five candidates were being hired.

Jill was one of them.

The Result: Jill Landed Her First Utilization Review Position

After months of searching and more than 100 applications, Jill accepted her first position as a utilization reviewer.

She did not get there because there was an easy shortcut into UR.

She got there because she had a strong clinical background, identified the gaps between her experience and the job she wanted, took steps to strengthen her candidacy, and kept going despite months of applications and rejection.

CMI gave her an important advantage: the opportunity to learn utilization management, gain hands-on experience with MCG, and earn MCG certification before she ever held a UR position.

When the right employer gave her the opportunity to make the transition, Jill was prepared to show what she already knew.

Jill’s Advice for Nurses Trying to Get Into Utilization Review

Jill encourages nurses interested in utilization review to prepare before the right job opportunity appears.

For her, that meant learning the fundamentals of utilization management, understanding insurance and Medicare concepts, gaining experience applying MCG criteria, earning her MCG certification, and continuing to apply despite setbacks.

Her experience also demonstrates why persistence matters.

More than 100 applications did not mean Jill could not make the transition. She needed to find an employer whose needs matched her clinical background and who was willing to train an experienced bedside nurse in utilization review.

When that opportunity appeared, she was ready.

Ready to Learn Utilization Management?

If you are a healthcare professional interested in transitioning into utilization management, CMI’s Utilization Management and MCG Fundamentals course teaches the UM process and provides hands-on experience using MCG Care Guidelines.

Successful completion also makes students eligible to sit for MCG certification.

Learn More About Utilization Management and MCG Fundamentals