yzarcrn

yzarcrn BSN, RN

prior auth
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yzarcrn has 22 years experience as a BSN, RN and specializes in prior auth.

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  1. Hi. I'm hoping one of you can help. Before the government side of the BCBS plan took over the medicare advantage product, the commercial side reviewed all prior auth and concurrent review cases. It is my recollection that if Medicare had a LCD or NCD...
  2. Blue Cross nurses...question

    Yes, that is true with all telephonic UR positions. My company does the same thing. There've been times when a nurse was stuck on a call for a really long time so the sup listened in on the call. However, this is usually to help the nurse stuck on th...
  3. Accused of being impaired, fired, now told I can't practice

    Hi. I'm sorry to hear you're having such a rough time. I'm still confused, though! If I was accused of being impaired and a safety risk and I knew it to be completely unfounded, I'd have my attorney all over them in a heartbeat. I feel like I'm missi...
  4. Case Management for insurance companies

    Hi! I've never done case management, but I currently work in prior auth for a major insurance company. I only did beside nursing for 3 years before I started, so obviously had zero experience and absolutely no knowledge of insurance. I honestly am no...
  5. I Should Be in Jail

    Wow. One of the main reasons I never went into pediatric nursing. I was able to detach myself when caring for adults. I don't mean detach as in cold and unfeeling, but able to pull myself together to continue to care for the next patient. I don't thi...
  6. Utilization Review Nurse at BCBS

    Hello. I know you posted this a while ago, but perhaps still helpful for you or others. I do UR for BCBS but not Anthem. Most UR/prior auth positions are telephonic reviews. Easy work if you are able to understand insurance. Some people get it, other...
  7. CCM Exam April 2016

    Good luck! I just took my exam in early December and passed. The good thing is you don't have to wait for your results, you find out right after you take the exam. I am generally a good multiple choice test taker and find most exams easy, but this w...
  8. Blue Cross nurses...question

    I do not recommend that company. They've had a change in CEO and let go of many very talented people. The company has lost its soul. Their focus is now on money and not so much on the good of the members and community they serve. I didn't work there,...
  9. First Case Mgt position

    It really depends. It's difficult to answer because there are so many variables. Experience in the particular area you are being hired for, insurance company or otherwise, etc. Whenever I was asked to enter desired salary when applying for a position...
  10. Prior authorization rep question

    If you are following a script/process flow and not making clinical determinations on your own then you are perfectly ok and practicing within your scope of license. Where I work we have staff who are not licensed clinicians approving certain requests...
  11. Yikes. There are no other nurses to share the burden? We have on call nurses but it is only after hours and on weekends and it is voluntary. If just your responsibility to take call 24/7 I would NOT take job. Clarification definitely needed.