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career choices CM orUR

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by nurse555 nurse555 (Member) Member

1,640 Profile Views; 37 Posts

I'm currently pursuing my ADN but am interested in continuing into either CM or UR. Would like some ideas or advice as to which choice would be best. Any ideas? Thanks!!!!!!

Robin

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122 Posts; 2,155 Profile Views

Good question- I am in the same boat as you. I noticed in the newspaper an ad for a CM. You needed eithe certification or a MSN in Case Management. I'm not opposed at all to getting my MSN, but is that the best route?

Cheryl

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835 Posts; 9,780 Profile Views

The two are kind of inter-related.

Case Management involves coordinating the care of the patient throughout the continuum, depending on the setting you will be doing the case management. Right now most of the case management jobs are in workers compensation, group health for high-dollar diagnoses, and catastrophic case management for conditions such as organ transplants, AIDS, burn patients, etc.

Utilization Review/Management is using established criteria (such as Interqual, Milliman & Robertson, or the company-developed policies) to determine medical appropriateness of authorization requests and facility length-of-stay's. This doesn't always require patient contact, unless you are doing utilization management in the hospital setting for discharge planning purposes.

When I hired new nurses for our case management department, I liked them to have a background in utilization management. Although it's not always necessary, it was definitely helpful when they has cases where their patient were admitted into the hospital and they needed to authorize their length of stay, home health orders and DME orders.

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37 Posts; 1,640 Profile Views

Thanks for the information. Most people I've asked act as if they don't want to be bothered so I appreciate your help. I'm trying to decide if I want to get my BSN or MSN after I finish my ADN and these areas interest me. Thanks again!

Robin

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ryaninmtv has 30 years experience as a ADN, ASN, BSN, MSN, LPN, RN and specializes in Case Management, Life Care Planning.

114 Posts; 2,880 Profile Views

I agree with LasVegasRN in the case management and UR are related. Where I work, we provide both services. With UR, we're looking for appropriateness and cost of care either on a prospective, concurrent, or retrospective basis. With case management (especially in workers comp) we try to guide the client through the system and help them return to work as quickly and safely as possible. Both are growing fields. Good luck.

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37 Posts; 1,640 Profile Views

Thanks for the input. I appreciate it.

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26 Posts; 1,340 Profile Views

I know this thread is rather old, but I am interested in getting in to case management as well. There is a college that offers a Bachelor Degree in Health Service with a concetration in Case Management for nurses with a Assoiate Degree. I was wondering if this is a good way to go. There is also a conference coming up about Medicare/Medicaid reimbursement and was wondering if this would be benificial or too far over my head. I am currently working as a staff nurse in LTC.

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