Hospital RN to Utilization Review ie Insurance Nurse

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    Ok guys, so I'm a CM at a hospital. I have IDTs, insurance reviews (Medicaid and Com), discharge planning, family conferences etc. I've been offered a spectacular job with a major insurance company which pays more and appears, at least on paper, like a better job.

    Has anyone out there made a transition from CM nurse to Utilization Review? My peers says working for insurance companies is, "crossing over to the darkside." The insurance job says I would have 3 patients a day. I currently have 30 patients working at the hospital.

    Any ideas or comments would be greatly appreciated.
    Last edit by pgnurse79 on Oct 9, '11 : Reason: typo
    lindarn likes this.
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  3. 11 Comments so far...

  4. 1
    Come to the dark side....we have cookies lol

    Seriously I have worked both hospital CM and Insurance and I will take insurance anytime!
    Nurserton likes this.
  5. 0
    Quote from pgnurse79
    Ok guys, so I'm a CM at a hospital. I have IDTs, insurance reviews (Medicaid and Com), discharge planning, family conferences etc. I've been offered a spectacular job with a major insurance company which pays more and appears, at least on paper, like a better job.

    Has anyone out there made a transition from CM nurse to Utilization Review? My peers says working for insurance companies is, "crossing over to the darkside." The insurance job says I would have 3 patients a day. I currently have 30 patients working at the hospital.

    Any ideas or comments would be greatly appreciated.

    Good luck. Thank you.
    Last edit by lifein08 on Apr 5, '12
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    I would just watch for positions for the case management positions for your hospital. The training for the position will include your community resources for items such as DME, Home care, Home infusion, etc.. You will also be trained in InterQual or Miliman depending on what criteria that your facility uses. Both of those systems are nationally accepted criteria to establish various levels of care. Some hospitals will train you in this or others may send you to a class.
  7. 0
    I'm with Delta32 to the OP. Personally I have the hospitals to be the dark side for case managers.
  8. 0
    I am a new grad and I am having trouble finding a job, esp without any experience. I have found a few non-clinical positions (Case management, Nurse Reviewer) that will hire new grads. My question is, will starting my career in non-clinical positions hurt my career or slow it down since I will not be practicing my hands on/patient care skills?
  9. 0
    Quote from delta32
    Come to the dark side....we have cookies lol

    Seriously I have worked both hospital CM and Insurance and I will take insurance anytime!
    I love CM , have experience in acute care, LTC, Home Health and Hospice, I am thinking about moving into insurance CM with BCBS. How do the two compare, and does anyone have any insights to how well BCBS compares to other insurance companies? What other insurance companies offer Nurse CM positions?
  10. 1
    @Chi Town, RN, BSN
    "I am a new grad and I am having trouble finding a job, esp without any experience. I have found a few non-clinical positions (Case management, Nurse Reviewer) that will hire new grads. My question is, will starting my career in non-clinical positions hurt my career or slow it down since I will not be practicing my hands on/patient care skills?"

    To answer your question, and this is my opinion..Yes, it will hurt your career to take a non-clinical position in nursing if you haven't developed your nursing skills and judgement. In order to do UM, CM, or any other job that requires nursing judgement, you need the clinical experience to build your knowledge and judgement. Most UM and CM positions require at least one year, which is the minimum, but prefer to have an experienced clinician...not a new grad. Good luck in finding your niche in nursing.

    Aloha from Hawaii.
    Nurserton likes this.
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    3 patients a day?? i dont believe it..
  12. 0
    Quote from pgnurse79
    Ok guys, so I'm a CM at a hospital. I have IDTs, insurance reviews (Medicaid and Com), discharge planning, family conferences etc. I've been offered a spectacular job with a major insurance company which pays more and appears, at least on paper, like a better job. Has anyone out there made a transition from CM nurse to Utilization Review? My peers says working for insurance companies is, "crossing over to the darkside." The insurance job says I would have 3 patients a day. I currently have 30 patients working at the hospital. Any ideas or comments would be greatly appreciated.
    3 patients a day? Sign me up!! I am a UM RN for a large health insurance company and my case load averages 45 patients. I review Medicaid patients daily, and Medicare every three days. Good luck with you're job search.


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