An ER has established a UR department under LC 4610 and hired a nurse to approve or deny requests. This is:

An ER has established a UR department under LC 4610 and hired a nurse to approve or deny requests. This is:

• A. Always permissible
• B. Never permissible
• C. Only a licensed physician may modify, delay, or deny requests for medical treatment
• D. Ok if the nurse has met CE requirements

Answer: (C)

Medical treatment decisions in utilization review must be made by a licensed physician. Under California workers’ compensation rules, a nurse can assist with information gathering and coordination, but the authority to modify, delay, or deny medical treatment rests with a physician who is qualified to assess medical necessity and appropriateness. So hiring a nurse to independently approve or deny requests would bypass the required medical oversight and is not permitted. Continuing education for a nurse does not grant the authority to make treatment decisions. The physician must oversee or directly perform those decisions.

Medical treatment decisions in utilization review must be made by a licensed physician. Under California workers’ compensation rules, a nurse can assist with information gathering and coordination, but the authority to modify, delay, or deny medical treatment rests with a physician who is qualified to assess medical necessity and appropriateness. So hiring a nurse to independently approve or deny requests would bypass the required medical oversight and is not permitted. Continuing education for a nurse does not grant the authority to make treatment decisions. The physician must oversee or directly perform those decisions.