gonzoRN

gonzoRN MSN, RN

Utilization Review, Critical Care, OR, SNF

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All Content by gonzoRN

  1. Has anyone taken CCMC Exam? Looking for advice.

    Deanna Gillingham's book CCM Made Easy is the gold standard. Her website is also a great resource. Good luck!
  2. I spent almost 6 years as an insurance UM nurse doing inpatient UM, and last year, transitioned to hospital UR. It wasn't difficult, however, it definitely took some adjustment. Specifically, the physician/RN relationship. On the payer side, it w...
  3. Relocate while under monitoring agreement?

    Relocating, for me, was a complete disaster, and extended my time significantly. Before you pack up that moving van, be crystal clear on your contract. After 2 years in a monitoring program, I moved to Florida. Rather than finishing out my origina...
  4. Hospital Utilization Review Question

    From my point of view, not interested in separate labs/imaging. If the results are included in H&P, progress notes, then it's redundant to send the extra. However, we don't generally accept your review--it's actual progress notes/H&P. If ...
  5. Insurance Case Management

    See below...
  6. New to Case Management-Any Advice?

    The insurance company, contrary to belief, is not your enemy. Find out who the health plan case managers are for your facility/unit/what-have-you and say Hi. I have relationships with acute hospital CMs/discharge planners all over the country, and ...
  7. Blue Apron, Hello Fresh, Etc. - Help with Meals

    I work 5-8s. My husband is/was the cook in our house. He loves it, I was always "meh", and never felt very imaginative. He went back to school full time, and I decided that I needed to pick up more of the cooking duties. I heard about these servi...
  8. I moved twice while on contract. Once to get away from a toxic marriage, and the other time to get home to care for a parent undergoing treatment for cancer. Both times, I had to physically go before the Board and petition for my license, and the r...
  9. CCMC Exam - no result!

    I took the exam in December and passed. I had read in multiple places that the new blueprint for the exam was going live in August and that results wouldn't be given right away. Sorry you guys had to wait! For those taking upcoming CCM exams, I u...
  10. Can a nurse be Disciplined in every state

    Not the whole process--just monitoring, mandatory group, and ... time.
  11. Advice on applying through insurance company.

    This is a great point. Have you looked into any of your regional health systems--many have their own insurance companies these days. The particular one I work for is actually more popular in my state than any of the National companies. The applica...
  12. Can a nurse be Disciplined in every state

    My last move was FL and into IPN. The move was necessary, to take care of a parent with cancer. The hardest part, believe it or not, was physically appearing before the BON. It was the most demeaning thing....standing there asking/begging to keep ...
  13. This. And you're not alone. I always say, I'm an introvert who plays an extrovert in real life. I was in CVICU for a longgg time, and the nightshift was a godsend. Our unit was designed in such a way as to make congregating together rather diffic...
  14. Can a nurse be Disciplined in every state

    My two cents. I moved twice during monitoring. Complete pain in the rear, but it can be done. However, both states made me start over. I completed over EIGHT years of monitoring. Since finishing, I've moved twice. Neither of those states required m...
  15. LPN job prospects in Abq/SF?

    The Albuquerque SNF market is pretty desperate for nurses, I personally know of more than a few buildings that have been using agency for a while now. PM me, Ill give you more info.
  16. New Mexico Highlands University RN to BSN...is anyone currently attending? Or graduated? I'd love to hear some thoughts on the program.
  17. Desperate for answers regarding IPN

    it sucked, but saved my life and my career. Do everything they ask of you with a smile. Never volunteer anything. Answer any question posed, but don't elaborate. Dont get complacent...in my case a little paranoia was a good thing. Ask support group ...
  18. Case Management for insurance companies

    Have you considered a regional health plan vs one of the major ones? Many delivery systems are getting into the health plan biz these days. My health plan services over half a million people in my area, and the whole application/interview process w...
  19. CCM Exam April 2016

    Hi there--I took and passed the CCM in December as well. I'm in utilization management so I was a little worried about this exam because of my narrow focus (I only do inpatient UM). I put a good amount of time studying for this test (at least it se...
  20. Insurance Haters

    I work for an insurance company in a combined UM/inpatient case management role. I don't know about ya'll but I am so very sick of the "insurance haters" out there who think that insurance companies, and those who work for them, are lower than....we...
  21. Aging Nurses - Where do we go?

    Yikes, I didn't know I was old at 52? My body ain't what it used to be, I can't work six 12s in a row (nights) and pop up and go skiing the next day. However, I moved on to something that didn't break my body--I work 8-10 hrs a day as a case manage...
  22. Insurance Haters

    I also believe health care is a human right. I would LOVE a single payer system. I would LOVE to be put of a job in that way. Do I think that it will ever be allowed in this country? Nope. And that is a very sad, sad thing. The problem is so i...
  23. Most nursing jobs requires clinical experience. If that doesn't interest you, rather than getting a BSN, why don't you consider an alternate path? My company requires RN case managers to have at least 5 years of clinical experience, preferably broad...
  24. Insurance Haters

    I do out of plan CM/UM for acute hospitals, acute rehab, LTACHs, and SNFs for a regional health system. Our health plan serves about 500,000 members across all lines of business. I work remotely, 100% phone and computer based. I absolutely love wh...
  25. Insurance Haters

    I really appreciate your comment. I was having a moment of frustration :) Almost all of my interactions with members have been positive. The negative interactions that I've experienced have come from providers. Particularly hospital discharge pla...