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by caprisonne

Aloha!

I've recently applied for a Utilization Management LPN position in the state of Washington. So far, the job application process is going well. I have been an LPN for over almost 7 years ... I have a military background (med-surg) as well as civilian med-surg background. I know what the job entails and have had the opportunity to work with people in the field, but salary never came up as I wasn't interested in the work at the time. I was really wondering if someone could give me insight as to a general starting hourly wage as I have no idea what would be a reasonable salary requirement request. I would appreciate any help here, and I realize the figures would be estimates and vary based on employer, location, etc. Thanks in advance for your time!

Cheers!
c.

[kjg1]

Re: Utilization Management LPN/LVN Salary Question ...

I have worked in Utilization Management for the last 14 years. I am an LPN. Usually these positions are salary, not hourly. Just starting out Try to get 43,000 settle fo 41,000 if you have to. Find out what their offer is first. I am from PA.

Karen

[Drifternurse]

Re: Utilization Management LPN/LVN Salary Question ...

What exactly is meant by utilization management?What tasks are involved in such a job?

[caprisonne]

Re: Utilization Management LPN/LVN Salary Question ...

Originally Posted by Drifternurse

What exactly is meant by utilization management?What tasks are involved in such a job?

Aloha!

Utilization management is a forward looking effort to manage health care cases efficiently and cost effectively before and during health care administration ... which is not to be confused with utilization review which is a more backward looking effort considering whether health care was appropriately applied after it was administered. To be a little more specific, utilization managment was explained to me to be a program which is the first step in monitoring and controlling the way a benefit plan is used ... enabling the benefit provider to ascertain the medical necessity of the services a patient may receive, ensure that the treatment is the most appropriate and cost effective, and most importantly, be able to identify high risk and high cost patients early on.


This is the job description they have:

Job Summary:

Conducts Medical / Surgical medical necessity reviews. Compiles information needed to process prior authorization requests and documents in the medical management system. Prepares and presents cases for Medical Director review. Refer cases to Case Management and Disease Management as appropriate. Identifies needs for process improvement and recommends changes. Advises non-clinical staff on clinical and coding questions.

Key Responsibility Areas:

o Conducts prior authorization activities and referral management activities.
o Assesses medical necessity by screening available information against established criteria, using InterQual Clinical Guidelines, Clinical Decision Support Tool, and Behavioral Health criteria. Ensures timely reviews for requesting facilities and notification to parties.
o Conducts care coordination activities and post-service nursing calls.
o Refers cases to Case Management or Disease Management for review as appropriate. Prepares cases for Medical Director and Peer Review.
o Coordinates discharge planning and completes necessary authorizations.
o Researches and collaborates with appropriate community resources to support discharged beneficiaries.

Hope that helps!
c.

[Drifternurse]

Re: Utilization Management LPN/LVN Salary Question ...

Originally Posted by caprisonne

Aloha!

Utilization management is a forward looking effort to manage health care cases efficiently and cost effectively before and during health care administration ... which is not to be confused with utilization review which is a more backward looking effort considering whether health care was appropriately applied after it was administered. To be a little more specific, utilization managment was explained to me to be a program which is the first step in monitoring and controlling the way a benefit plan is used ... enabling the benefit provider to ascertain the medical necessity of the services a patient may receive, ensure that the treatment is the most appropriate and cost effective, and most importantly, be able to identify high risk and high cost patients early on.


This is the job description they have:

Job Summary:

Conducts Medical / Surgical medical necessity reviews. Compiles information needed to process prior authorization requests and documents in the medical management system. Prepares and presents cases for Medical Director review. Refer cases to Case Management and Disease Management as appropriate. Identifies needs for process improvement and recommends changes. Advises non-clinical staff on clinical and coding questions.

Key Responsibility Areas:

o Conducts prior authorization activities and referral management activities.
o Assesses medical necessity by screening available information against established criteria, using InterQual Clinical Guidelines, Clinical Decision Support Tool, and Behavioral Health criteria. Ensures timely reviews for requesting facilities and notification to parties.
o Conducts care coordination activities and post-service nursing calls.
o Refers cases to Case Management or Disease Management for review as appropriate. Prepares cases for Medical Director and Peer Review.
o Coordinates discharge planning and completes necessary authorizations.
o Researches and collaborates with appropriate community resources to support discharged beneficiaries.

Hope that helps!
c.

Thanks for such a detailed explanation--that really helps! It sounds interesting.

[just1]

Re: Utilization Management LPN/LVN Salary Question ...

Find out what staff nurses in your area are making and take it from there. I worked in UR in the mid-90s, made $4000-5000 less per year than staff nurses supposedly because we worked no weekends/evenings/holidays, no lifting or exposure to body fluids, etc. I had surveyed multiple hospitals across the country at the time and found this to pretty much be the trend. It was a good job and I enjoyed it, even at the lower salary.

[HaydenK808]

Re: Utilization Management LPN/LVN Salary Question ...

Originally Posted by just1

Find out what staff nurses in your area are making and take it from there. I worked in UR in the mid-90s, made $4000-5000 less per year than staff nurses supposedly because we worked no weekends/evenings/holidays, no lifting or exposure to body fluids, etc. I had surveyed multiple hospitals across the country at the time and found this to pretty much be the trend. It was a good job and I enjoyed it, even at the lower salary.

While at a lower salary being a RN, the position that the person is going for is for an LPN. I would think that it would be a wage increase from bedside LPN salary.

Either way I am glad you enjoyed the job switch. I know many bedside nurses LPN & RN who are getting burned out and something like case management is just the cure to maintain sanity while still working in the same organization, keeping the seniority & 401k etc.