Utilization Review - page 2

by Sherriblu | 38,917 Views | 19 Comments

How does one get started in doing Utilization review? Do you have to have a certificate and where does one get that? I have done floor nusing for many years and need to get off the floor.. Thank you..:yeah:... Read More


  1. 0
    Hi Nurserton,

    I have been a nurse in the hospital setting for almost 2 years now and am becoming burnt out and the idea of being a UR nurse intrigues me. Is it possible to obtain a job doing this with the little experience I have? Thanks!
  2. 0
    Quote from Aernton
    Hi Nurserton,

    I have been a nurse in the hospital setting for almost 2 years now and am becoming burnt out and the idea of being a UR nurse intrigues me. Is it possible to obtain a job doing this with the little experience I have? Thanks!
    It's possible, but honestly, probably not likely. It depends on the diversity of your experience I guess. I had 4 years of experience but very varied - outpt, floor, step-down, icu, charge nurse, some quality, outpt case management, etc. It may be better that you take advantage of your clinical "momentum" at this point in your career. I would caution you to make sure you don't want to go back to bedside/direct patient care because once you're out for a few months, you will have a hard time getting back in. Many places even require nurses to take a refresher course. There are many ways to grow and alleviate your boredom within the realms of patient care. That doesn't mean you should rule out UR..always have that goal i mine when crafting your resume. I do really enjoy my current position and given my combined 10 years patient care experience I was ready. But remember, you have a whole life of nursing, no need to rush. The beauty of it is the ability to have so many varied experiences and all of them qualify as nursing, and better yet, all of them will qualify you as a UR nurse. Good luck in whatever you choose to pursue.
  3. 0
    I have been a psych nurse for approx 30 yrs, the last 5 in forensics. d/t a recent back injury, I cannot continue in psych nursing at the AA degree level which involves direct pt care, including takedowns etc. I never did acute med surg, only acute psych. I'm wondering without the acute med surg experience if I would have a difficult time being hired into any of the following: UR, case management, or MDS. D/t my age, 61, and being out of time and money (1 yr on SdI , ) I am looking for the quickest way to employment, without waiting for advanced training. I don't mind training into a job that will train you on the job or ask you to take some additional certification courses while employed. I just don't see that a long journey to a bachelors and then a masters makeing sense at this time in my life. Of the 3 choices I mentioned which would be the best to start with, and then to progress on to. I see courses for RN to MSN if you want to to case management. Is that really necessary? Bewildered and Betwixt
  4. 0
    I would look into Behavioral Health Case Management or UR with an insurance company or hospital. Try Cigna, United Health Care, Anthem (WellPoint), etc.
  5. 0
    Quote from CDeCapua
    I have been a psych nurse for approx 30 yrs, the last 5 in forensics. d/t a recent back injury, I cannot continue in psych nursing at the AA degree level which involves direct pt care, including takedowns etc.... Bewildered and Betwixt

    It will depend on where you live or the companies in the area. Many require a BSN and/or years of case management work experience. I doubt becoming a case manager is the quickest way to become employed as a nurse unless you know a hiring manager who will be willing to train you despite your credentials. In fact, that is my best suggestion.

    Talk to your former employers and ask the hiring managers of the case management departments. If there was no CM department, then look at becoming an admitting nurse in Psych or for a SNF. With your past work experience, I cannot see why no one would be interested. Good luck.
  6. 0
    There is a CPUR credential, promulgated by a well-known company that shall remain nameless but is famous for inventing credentials and then making tons of money off of the people who want them. You pay for the course and books and exam, and take the course in the morning, take the exam in the afternoon, and pay to take all the required CE to recertify. We are talking big bucks here.

    I walked in to the afternoon session having paid for the exam only and aced it on the basis of having worked field case management in work comp for six years and picking up a few of the handouts that somebody dropped on the floor at lunch break. I thought the whole thing was totally bogus and never even put it on my resume. It was, I guess, an expensive afternoon's entertainment, but I did want to see if this "certification" (which it isn't, it's a certificate) was really indicative of any special knowledge or capability. It wasn't, in my opinion.
  7. 0
    If anyone know what the online service that are used by insurance companies and facilities to give guidelines base on age, service, and co- mobidities could you post it . I want to increase my knowledge in this area of nursing.
  8. 0
    Quote from Ptrcthllh
    If anyone know what the online service that are used by insurance companies and facilities to give guidelines base on age, service, and co- mobidities could you post it . I want to increase my knowledge in this area of nursing.
    Interqual criteria or Miliman criteria are the two programs used in Case Management/UR.
  9. 0
    Mersekrn, I see you are in OH do you work directly for Aetna or are you an AHH employee, under Aetna?
  10. 0
    Mersekrn, I thought I posted this but not sure where it went :-). I see you are in OH, do you work directly for Aetna or AHH ??


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