Utilization Review Utilization Review - pg.2 | allnurses

Utilization Review - page 2

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... Read More

  1. Visit  pfchang profile page
    #13 1
    I would look into Behavioral Health Case Management or UR with an insurance company or hospital. Try Cigna, United Health Care, Anthem (WellPoint), etc.
  2. Visit  MBARNBSN profile page
    #14 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.
  3. Visit  nurseprnRN profile page
    #15 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.
  4. Visit  Ptrcthllh profile page
    #16 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.
  5. Visit  NRSKarenRN profile page
    #17 2
    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.
  6. Visit  Nextcase profile page
    #18 0
    Mersekrn, I see you are in OH do you work directly for Aetna or are you an AHH employee, under Aetna?
  7. Visit  Nextcase profile page
    #19 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 ??
  8. Visit  Concern123 profile page
    #20 0
    Hi there,
    Is it anyway we can communicate because I would like help obtaining a job as some kind of review nurse. Please email me at allenkiat@msn. I would really appreciate your help.
  9. Visit  Ani-nurse profile page
    #21 0
    Hi , I was wondering if you still do UR as a nurse . I'm at the bedside for 10 years now and I'm lookin for a position like that to work from home . Have you heard of care manager RN ? Thanks
  10. Visit  smustapher27 profile page
    #22 1
    There are several types of nursing jobs that allow you to work from home such as HEDIS, utilization review, clinical documentation improvement, RN coder, case management, auditing, etc.
  11. Visit  laney1733 profile page
    #23 0
    I have been trying to get into utilization review for over a year now. I'm only targeting certain employers so I know I'm limiting my odds but is there anything that anyone can offer as far as advice to either alter my resume somehow or gain a specific type of training or experience to help me to break into this area of nursing?. I have four years of acute, hospital experience and just over a year as a home health case manager, BSN-RN licensed. Any advice or input would be very much appreciated. Thank you
  12. Visit  smustapher27 profile page
    #24 0
    Typically, UR jobs only require a nurse with 3-5 years of acute care experience. I had only been a RN, BSN for 3 years when I obtained my 1st job offer as a UR Nurse. Stay persistent in your job search. Good luck!
  13. Visit  laney1733 profile page
    #25 0
    Thank you for the encouragement, I appreciate it!