Hello all I am starting my new utilization review Rn position next week for a big insurance company in NYC and I would love any advice, warnings, or anything else you wish to offer to help me during those first weeks. I am a new utilization review nurse but I do have an extensive Er back ground as well as gi, ICU step down and tele experience.
No case management experience. This is a great opportunity as they are willing to train me and pay pretty well for training me. I am excited and scared......
Thanks in advance for the replys.
Jul 19, '12
Congrats! As you can see this isn't a very active thread. I left ICU nursing for utilization management about 5 months ago. It's a whole different ball game.
As I'm not sure if your specialty is going to be inpatient, ambulatory or quality I can't really give too much advice. But if it IS inpatient, my experiences so far recommend this:
Find out what exactly is your job versus the Case Managers/Discharge Planners at the hospitals job. When I first started I kept having Case Managers at the hospital try to pull one over on me because they knew I was new and were trying to get me do their job for them. We try to help when we can, but our roles are different. I had one situation where I pretty much did all the work in getting this guy to a subacute for about a week (mostly trying to find one to take him!), but he would have spent months in the hospital had I not done the leg work. This was a very particular situation though where the facilities wanted proof the insurance company would pay.
Templates - make sure to get anything and everything they have depending on what you need. Where I'm at, I'm still finding out about different useful tools, but our training program pretty much doesn't exist.
Be willing to learn from anyone and everyone, always be a team player, even if most of your team isn't team players. I've noticed many case managers at my facility are sort of solo acts, they like kind of doing things on their own in their own way, but honestly, it makes the job more difficult for everyone when someone is out for a day.
If your computer knowledge is limited, I'd recommend seeing if they offer a computer class through your work. I knew nothing about excel 5 months ago..I use it almost daily!
Hope you enjoy it! I really like it, the hours and pay are so much better than what I did before. It's nice to feel like we're contributing to helping reduce the amount of government spending going to waste and trying to help keep people out of the hospital.
Jul 20, '12
Inpatient is what I am going to be working on....thanks for your reply:-)
Aug 15, '12
Hzrizen- How are you liking your new job? What is your day like? Just curious. Hope it's going well.
Aug 18, '12
Great day thanks. Lots of terminology and different processes to get accustomed to. I always have to remind myself I'm on the business side of things and not at the bedside. It's different to advocate for the patient when there are rules and regulations and criteria involved. The pace is different and takes some getting used to. Everything is beginning to come together and it's been 2 weeks which feels great. Day by day I'm becoming more comfortable so I'm sure it's gonna bet much better. It's a bit overwhelming like some have said but there is light at the end of the tunnel. This week I'll have my first hospital with out direct help. I'll let u know how it goes :-)
Aug 19, '12
Sounds like it is going well. I always wondered what UR would be like. I would see the UR nurses at the hospital running around, and was curious about it. Hope this week goes well. Please do keep us posted. I am still looking for my niche, and this area is one of many I have my eyes on. Hope it works out well for you!
Oct 17, '12
Just wondering if you're still around, how you're doing in your UR job? I'm leaving the bedside in a couple of weeks for a UR position with an insurance company doing inpatient also. I'm really nervous to leave what I know but also very excited for the opportunity. How have you adjusted? Do you miss the bedside at all?
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