An employer's UR department hires a nurse to approve or deny medical treatment requests. What qualifications must the nurse have?

• A. Must have a doctorate in medicine
• B. Must have a valid nursing license
• C. Only a licensed physician may modify, delay, or deny request for medical treatment
• D. Must have completed a specialized certification in UR

Answer: (C)

The correct answer emphasizes that only a licensed physician has the authority to modify, delay, or deny requests for medical treatment. This highlights the critical role that a physician plays in ensuring that medical treatment decisions are made based on comprehensive clinical evaluations and expertise that nurses, regardless of their qualifications, cannot provide at the same level.

In the realm of Utilization Review (UR), while nurses are often involved in the process and may assist in evaluating treatment requests, the final authority to approve or deny requests typically rests with a physician. This ensures that medical decisions are guided by a deep understanding of medical practice, ethical considerations, and legal implications, which are integral to the treatment process.

The other qualifications mentioned relate to nursing credentials and certifications. While a valid nursing license and specialized certification in UR are important for nurses working in the UR department, they do not grant authority to deny treatment requests, which is reserved for licensed physicians. The incorporation of physician oversight in UR processes is vital for patient safety and adherence to medical standards.