Case managment and UR in one role

  1. Is there anyone working as a case manager and utilization review nurse? Need some suggestions on how both roles can be one. What is your caseload? How many reviews are you expected to complete a day? Do you perform concurrent, outpatient, pre cert reviews on all your patients. How are your cases assigned to you? This program will be implemented in a health plan. Any help would be greatly appreciated.
  2. Visit Kgantt profile page

    About Kgantt, BSN

    Joined: Jan '08; Posts: 31; Likes: 5
    from US


  3. by   nurseprnRN
    In our state you can't do both for work comp because it's a conflict of interest. I'd be interested to hear how this works.
  4. by   Kgantt
    I will let you know as soon as I get some more information regarding expectations. What state are you in?
  5. by   SummerGarden
    My CM career is in the hospital setting thus far. When I work as a discharge planner (Case Manager) and a UR nurse all wrapped up in one, my case load is based upon the floor I work (inpatient or ED). When I worked inpatient I had as many as 40 patients a day, where I performed assessments, coordinated discharge plans with other providers, obtained resources and equipment for patients, and safely discharged patients home or to other settings AND performed UR. When I work as a UR nurse only I perform admission, concurrent, and retroactive reviews on a caseload of usually 20-40 patients per day. I also provided denial letters and other letters in both cases from insurance companies.