Case Management/Utilization Review?

rearviewmirror, BSN, RN · May 21, 2018

I don't work from home (have been offered but I prefer not being stuck home every single day) but I am doing UR in an insurance company (third party admin to be more exact).

Yes you need your RN license and active status to be able to work in CM or UM, and they look for RNs as you are still using clinical judgments and skills learned from bedside to make decisions after reading clinical. I highly doubt any companies allow their nurses w/o any CM or UM experience to allow them to work at home immediately upon hire; more plausible scenario is you would be working up to 6 months after showing consistent outcome and productivity, then let you work at home.

I would highly encourage you to apply EVERYWHERE. I literally applied to any job post that had "CM" or "UM" for insurance companies. It is realistic to expect to be offered at smaller companies or TPAs than the big-box companies, though not saying you won't be offered there, as they look more for experienced candidates. I did phone first and then face-to-face, was called by director who interviewed me and got an offer via phone. Sell yourself; good luck!

Guest757854 · May 25, 2018

^^^^^^^THIS!!!!!!!!!

mcmoo · May 26, 2018

Thanks for the info. Do you think 5 years as a floor nurse is enough experience or should I broaden my nursing knowledge first and get some experience in other areas (LTC, HH etc).

Jory, MSN, APRN, CNM · May 26, 2018

Can any nurses that currently are in CM or UR and work from home through an insurance company offer some advice as to how to be successful in finding these types of positions? I am an RN (ADN) with 5 years of floor experience (2 yrs in cardiac step down/3 yrs in ortho). I left the floor in 2014 to nurse my back/hip injury while also caring full time for my elderly parent. I would like to be employed again but feel that the floor may be too difficult for my body. CM or UR seems right up my alley (I also have a business degree) but I have questions: Do I need my BSN? Do you need to live near a big city and work "in house" first before working from home? Are interviews face to face or video interviews? How did you get noticed and ultimately become hired? It seems like this a desirable, in demand job to get but sure would like a chance at it. Any advice would be greatly appreciated.:)

Yes, you will most likely need a BSN and I have seen many facilities require a MSN. It would be very difficult for you to obtain a position without working in discharge planning or UR at a hospital first because I strongly feel you need to see it from the hospital side to truly appreciate the insurance side.

There are tons of nurses working as a CM that have had injuries. You can apply to work in UR without working in discharge planning, which is a faster pace position.