Utilization Management (UM) is one of the many nontraditional bedside jobs a nurse can pursue. In this article, we will look at what utilization management is and how to move into this position. 

Defining Utilization Management and Utilization Review

URAC (formerly the Utilization Review Accreditation Commission), a nonprofit organization promoting healthcare quality by accrediting healthcare organizations, defines utilization management as “the evaluation of the medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities under the provisions of the applicable health benefits plan.” Utilization management describes proactive actions such as discharge planning, concurrent review, and precertification.