What does a utilization management nurse actually do—and is it the right path for you?

In this episode, I sit down with Jessica Smith, LPN, who has built her career in utilization management and prior authorization after starting in ICU, burn, and outpatient nursing. We break down what this role really looks like day-to-day, how nurses use clinical judgment in an insurance-based setting, and how you can break into this field.

We also talk about the realities of remote nursing, including the flexibility, the challenges, and what nurses should know before making the transition.

If you’ve ever been curious about nontraditional nursing roles or are looking for a path away from the bedside, this is one you don’t want to miss.

In this episode, we cover:

• What utilization management and prior authorization nurses do

• A typical day working in UM

• How nurses apply clinical judgment outside the bedside

• How to break into the field (even as an LPN)

• The pros and challenges of remote nursing roles

• Tips to stand out and get hired

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