If an ER's UR department uses a nurse to approve or deny requests for medical treatment, which statement is correct?

• A. Yes, a nurse may approve or deny requests.
• B. Yes, but only under physician supervision.
• C. Only a licensed physician may modify, delay or deny requests for medical treatment.
• D. The ER UR nurse may independently modify requests.

Answer: (C)

The main concept here is who has the authority to modify, delay, or deny medical treatment in utilization review decisions. These are clinical judgments, and they must be made by a licensed physician. A nurse in the ER UR department can assist by collecting information, applying medical-necessity criteria, and documenting findings, but the final decision about changing or denying treatment rests with the physician. This ensures decisions reflect medical expertise and standards of care. Therefore, even with supervision or a nurse’s involvement in the process, the authority to independently modify or deny treatment does not lie with the nurse.