differences between UM and CM

OP: Your post reads as if you only perform UM/UR on your job. This does not make you less of a Case Manager. UM is Case Management.

To answer some of your questions... I have a PT job, where I only perform UM/UR on a case load of active and inactive patients. The reports I develop are sent to insurance companies so that the hospital for which I work receives proper payment. On the other hand, I have a full-time job, where I perform UR and I have an active case load, where I must assess patients in-person and make clinical decisions regarding proper admission and dispositions of patients from the hospital setting (which is what I think you mean by "CM").

The difference between my two jobs is that I am actively involved with patient care in my Full-Time position rather than my Part Time position. Specifically, I discuss cases with the healthcare teams, perform UR, and I advocate and intervene (when problems arise) with medical courses of treatment for patients in real-time, as well as, facilitate proper discharge.

Many times I find that my FT job is more stressful than my PT job because of the stressors related to what I encountered working as a bedside nurse; customer service applied to crazy and/or violent patients and family members. Good luck.

Some places combine UM and CM. I work for a place where they're separate.

Our UM nurses call hospitals for clinical information on patients, write notes on the patients, and approve or deny hospital stays. They have UM reps who handle routine approvals of procedures and doctor's visits.

Our CM nurses (all telephonic, no field work) call new members and perform assessments and see if they need any assistance. We help people deal with illnesses, find doctors and specialists, give members information on disease, assist them in getting medications and procedures and medical equipment and follow up with them after hospitalizations.