A UR department nurse can independently approve, modify, delay, or deny requests?

A UR department nurse can independently approve, modify, delay, or deny requests?

• A. True
• B. False
• C. Only with CE credits
• D. Only for emergency

Answer: (B)

In utilization review, medical necessity decisions are medical determinations that require a clinician with appropriate authorization. A UR department nurse can collect information, perform initial screening, and make recommendations or flag issues for physician review, but they do not have the independent authority to approve, modify, delay, or deny requests. The final determination rests with the UR physician or medical director, guided by policy and clinical guidelines. In emergency situations, care can be expedited to stabilize the patient, but the ultimate coverage decision is authorized by a physician as soon as possible. So the statement is not correct.

In utilization review, medical necessity decisions are medical determinations that require a clinician with appropriate authorization. A UR department nurse can collect information, perform initial screening, and make recommendations or flag issues for physician review, but they do not have the independent authority to approve, modify, delay, or deny requests. The final determination rests with the UR physician or medical director, guided by policy and clinical guidelines. In emergency situations, care can be expedited to stabilize the patient, but the ultimate coverage decision is authorized by a physician as soon as possible. So the statement is not correct.