ljkeene

Most utilzation jobs that I am aware of pays less, I guess because they can. There is always someone who will take the the job for the pay they offer. Nursing happens to be one of the few jobs/professions where you earn a decrease in pay the longer you are in the profession. They want and need your clinical expertise but because they can get away with it they pay less. With that said I do like what I do and after decades on the floor it is much easier on the body.

What a valuable lesson. Now whenever you have to calculate a medication you will be reminded of this incidence and be extra careful. You must have a good instructor that has the insight to make this into something you will always remember. It may save you from a lethal dose of some other kind of medication in the future. I remember 30 years ago as a new grad that i miscalculated a heparin dose and gave 10 times the dose I should have. I had to face the surgeon and tell him what I did. He just said to watch the patient and there were no adverse effects but that incidence was so potentially dangerous on that fresh open heart patient and the implications of what could have happen was so scary that I have never calculated another medication in the past 30 years that I did not give without being absolutely positive it was the right calculation. Great lesson to learn so early on.

If you have years of floor experience you have some good experience to get started. Hospital utilization review is a bit different than insurance company utilization review. I am more familiar with hospital based review than insurance. Utilization usually does concurrent reviews of what is going on with the patient during the time they are in the hospital. Most hospitals use either Interqual criteria or Miliman criteria in which the nurse follows a set of criteria to determine if the patient's stay is medically necessary and if there is an intensity of service (receiving a level of care) that justifies hospitalization. You would probably be trained in that program after being hired. You will need to have a basic understanding of how both insurance and medicare works. Many hospitals are also using utilization review as documentation specialists where the reviewers also review the physicians documentation and what is going on with the patient and then querries the doctor to make sure that what the doctor is thinking and what he is treating is accurately and thoroughly doumented so that full reimbursement can be obtained. Medicare pays more for some diagnosis than others, but doctors do not always clearly document that and revenue is sometimes lost. there is certifications available but usually you have to work in a certain field for a year or two before taking the certification. Long answer but it is a good job for us older nurses whose knee can no longer take 12 hour days running all day long. I currently work in medical auditing and that also is an interesting area much like utilization review.