Utilization review nurses

*smir953328* · Nov 25, 2008, 05:11 PM

Originally Posted by URnurse1988

Any UR nurses out there that work for an insurance company or TPA?

I have been working in the medical management industry for 8 years. Started out as a UR nurse for a small TPA, then starting training new employees as an extra duty. Did Level 1 CM for about 6 months while still training new employees. Became the UM supervisor + trainer. Both became too much to handle as the company continued to grow, so I stayed with the training aspect and focused on developing a full new employee orientation program. I did the training for about 5 years. After going through two buyouts and larger corporations taking control, I went back into the UM world and currently is a supervior for one of our five locations nationwide. I am trying to juggle work (50hr/wk), family, school. I think I am close to burnout and thinking of giving up my UM position which I really enjoy.

I can't do school and work those crazy hours with a 2 hour round trip commute to boot.

Sorry got so long winded.

cindynavarro · Apr 23, 2009, 03:26 PM

I am an RN with ICU experience. I injured my back and currently on disability. I still would like to work as an RN but cant do bedside anymore. I want to take the class for utilization review but dont know where to start. can somebody please tell me where to go for the class and how long will it take to finish it? thank you so much. any info is great.

cindy

merrymary · Oct 12, 2009, 07:05 PM

Originally Posted by URnurse1988

Hey,
You would probably be good working for an insurance company with your many years of varied experience. There are different jobs you can do working for an insurance company i.e. medical necessity reviews, pre-certification of hospitalizations, case management of patients with catastrophic diagnosis such as cancer, wellness coaching, disease management of chronic disease such as diabetes, CHF, CAD, COPD. If you currently work at a hospital, you could ask your case management/utilization review dept. if they know of any insurance companies looking for nurses. Sometimes you can work from your home. Usually the hospital case management/utilization review nurses speak to insurance company nurses everyday. You could also call the big insurance companies Cigna, Aetna or others in your area and see if they have any positions or you could just send them your resume. I have been working for an insurance company doing utilization review for the past 18 years and I don't miss direct patient care one bit. I love the Monday to Friday 9 to 5 hours. Good luck!

Do you have good benefits and do you make as much as you would if you did hospital nursing for 18 yrs?

Mijourney · Jan 15, 2010, 06:17 PM

Hi everyone. For those of you that have worked both UR and triage, which area would you choose and why?

Utilization review nurses

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