Utilization Review---does anyone know anything about it? What is it like?

Nurses General Nursing

Published

Hi all,

I am currently a day surgery nurse where I work in a specialized environment, assisting the doctor and staff in fixing dialysis patients' dialysis access. I have been here for three years and previously had a (brief) time in pediatric med surg and then a few weeks of an internship in the ICU. Suffice to say, I HATED bedside nursing (it really just isn't for me...no matter how hard I try to make it work, it never has been a good fit for me).

Anyway, I ramble-- I am looking to make a possible career change over the next year...maybe sooner. Can anyone give me a candid opinion on what it is like to be a utilization review nurse? What about the job do you like? What about the job do you hate? Do you spend time on the unit floor, or do you work behind a desk all day? I appreciate all comments....I want to know the awesome, the good, the bad, the ugly, and the really ugly (stuff no one tells you about re: a job because they don't want to be mean). THANKS!

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Hi Imperialsugar- I don't have UR experience, but it has interested me, too. There are some posts over in the "Case Management" forum under the "Specialty" tab. If no one reponds here, there are some threads over there to check out. Good luck!

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Specializes in Telemetry, Case Management.

I work for an insurance co in UR. It's great. There are two sets of standards, Milliman and Interqual. You measure the patient's stay by these standards, and make sure both the provider and the insurance co can agree on length of stay and/or procedures. It utilizes your nursing judgement, no weekends, no holidays, only twice in four and half years have I had to work overtime. I was at the bedside nearly twenty four years before I went to UR. With any luck, I'll never have to go back to it.:D

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I could never do it in any sort of organization that denies diagnostic testing or procedures that end in severe damage or death d/t delay- and the "fight" the patient has to juggle when just trying to get well.

If it's just a matter of being sure the resources are being used prudently- that's another situation....

Just remember, that UR are the folks that shove people out of the door when the doc wants them to have some additional time to get well (that's not against the UR individuals- but the really shady concept that someone in an office 400 miles away with no medical degree is dictating treatment). JMO

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Specializes in Utilization Review.
I could never do it in any sort of organization that denies diagnostic testing or procedures that end in severe damage or death d/t delay- and the "fight" the patient has to juggle when just trying to get well.

If it's just a matter of being sure the resources are being used prudently- that's another situation....

Just remember, that UR are the folks that shove people out of the door when the doc wants them to have some additional time to get well (that's not against the UR individuals- but the really shady concept that someone in an office 400 miles away with no medical degree is dictating treatment). JMO

Isn't that why they hire RNs with experience to fill these rolls? Honestly the docs sometimes ask me how much longer I think the patient should stay... not the other way around. Some doctors will not discharge until the RN advocates for them to go home. I think UR is a great way to make sure patient's aren't going to get slammed with a huge bill because their doctor who they were trusting to make the right decision wanted to keep them an extra day to cover their ass.

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