Enhancing the Competency of Utilization Review Nurses Through 21st – Century Skills: Case Study of Golden Jubilee Medical Center, Faculty of Medicine Siriraj Hospital, Mahidol University

Abstract

A Utilization Review Nurse plays an important role in private health insurance services provided by hospitals. The main job description includes six duties: 1) Ethical aspect and law; 2) Nursing and midwifery practice; 3) Professional characteristics; 4) Academics and research; 5) Communication and relationships; and 6) Technology and information. In essence, the quality of utilization review nurses is crucial for a hospital's private health insurance service. They must have comprehensive medical knowledge across all fields and various operational skills, as they often collaborate with diverse societal groups, encountering frequent work-related challenges. These challenges may include lack of up-to-date medical knowledge covering all fields, absence of current insurance knowledge, poor communication quality, and complexities in coordinating with insurance company’s claim systems, all of which affect nursing efficiency.

This article proposes the adaptation of "New Future Skills: Learning in the 21^st Century" from The Partnership for 21^st Century Skills, encompassing three aspects: 1) Learning and Innovation Skills; 2) Information, Media, and Technology Skills; and 3) Life and Career Skills. This can enhance the skill set of utilization review nurses in all six aspects mentioned above: becoming a nursing professional in the 21^st century, equipped with abilities in medical science, nursing knowledge, information literacy, information and communication techno- logy literacy, as well as life and career skills, to effectively care for patients both physically and mentally.