Alizza RN

http://www.ltuextension.com/ This site have programs to learn Medicare Regulations Compliance and Payment - an intro to learning Medicare.

Email me if you need to know more... [email protected]

Depends on what you are doing now... are you doing anything that is related to healthcare policies, case and disease management, medical necessity issues, understanding of Medicare reimbursment methodologies, knowledge of ICD 9 CM, HCPCS, APCs, DRGs, Risk adjustment models, MDS, RUGs, bill review and fraud and abuse/compliance issues, encounter data, RBRVS, quality intiatives related to medicare, stats and Medicare cost... too many to mention. If you are in any of these areas - you are on the track. I find that many of our colleagues in our nursing profession do not want to have anything to do with these and nothing is wrong with that. But for those that would like to be involved in areas more than acute and subacute care nursing, this is a good chance to be involved --- because one day we all are going to be beneficiaries of Medicare or Medicaid.

Nurses would also do great as Medicare compliance officers or specialists. This would not only be an opportunity to work in an HMO environment, but to all health care org. as well. Compliance is so BIG in the eyes of the government that it is a requirement to have compliance programs in all entities. Nurses fit perfectly in this area - the clinical combination, the versatility and the ability to detect fraud and abuse is not only a talent for lawyers but for nurses too. Learn Medicare from head to toe and that should get you in.

I disagree with the previous RN re: 1-2 years experience in an insurance employer. I am a RN Healthcare consultant dealing with case mgt. UR, clinical review/medical audit, disease management, coding and reimbursement, government contracts in policies and medicare issues all of whom and allowed me to travel and deal with nurses and other HC prof all over the country - hospitals and all types of payors. UM is only one of the options working in an MCO - managed care org. There are other opportunities - case managemnt, quality and risk mgt, HEDIS and performance measure jobs, clinical and bill audit review, compliance and many others. Your 5 year acute care experience is a good start. You need to take few courses depending on your interest - UM/CM, learn coding and reimbursement methodologies, understand the intricies of Medicare as a payor and deliverer of care. membership to professional org of these specialties are also helpful. Pay is equitable now with all the RN shortage around. Most of them require BSN. PC skills is a must and writing summaries and analytical talents in graphs and tables is a plus. Any more questions - email me. Good Luck......