utilization review

  1. what does a utilization review nurse do?
    what about career advancement/prospects in that field?
    what do they usually make?
    thanks!
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  2. 3 Comments

  3. by   Wren
    kimmykng,
    Sorry that you haven't gotten an answer yet. I have worked in UR but it has been awhile. Most UR nurses work for an insurance company/health plan or state program. They receive a request from a provider for a patient to have a service (surgery, in-clinic procedure, out-pt therapy, etc). The nurse reviews the request for medical necessity and whether or not the patient's insurance provides a benefit for the requested procedure. Most places use one of two guides (InterQual or Milliman and Roberts) to review by. So if a procedure "meets" the guideline in InterQual...the nurse approves the request. If if doesn't meet the guidelines then the request is often referred to a supervising physician. It is actually not as boring as it sounds!

    I don't know what the current salaries are but I do think that career advancement is fairly good but that is depending on where you want to head from there. Good luck!
  4. by   kimmykng
    thank you very much for your response.. i'm starting my UR career now! still getting used to it.. but i lke it so far.. especially the hours! no weekends, holidays, PTO's..
  5. by   URanurse
    I worked UR for two years and that was three years ago. To make myself more marketable and return back to UR, I want to take the CPUR exam. Have you taken the CPUR? McKesson offers a self study course for $150. I was wondering how fast I could take the self study if I actively pursued it? Can I buy the study guide cheaper somewhere else and McKesson still recognize it? Thanks.

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