What's utilization management like?

Nurses General Nursing

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I'm currently DON in a LTC and can't take the stress and long hours any more. Don't get me wrong, I'm doing a great job. Just passed survey with flying colors. But in the past 3 weeks I've had 1 day off and my bosses feel that's just how it's supposed to be.

So I applied for a position as "Utilization Management Manager," and a recruiter called me today. I'm wondering what a day in the life of a utilization management manager would be like. I'm especially wondering if they get out of work on time and get their weekends off.

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I'm a UM manager and I make sure to have work life balance. But again, that's give and take. There are some weekdays I work long evenings and those weeks I don't work on the weekend, so it highly depends on how I balance my work. Is this a UM manager position for a payer company or hospital? There is a difference. PM me if you have specific questions.

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Thanks for your response. It's for a payer. I'm wondering how the stress level would compare to my LTC DON position. The same corporation has a utilization review nurse position open and, although it would pay significantly less, I'm willing to take a pay cut for lower stress and fewer hours than I'm experiencing in my current position

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Respectfully, a UM manager role on the payer side can be very stressful as you are up against many departments including marketing/sales, compliance, legal, operations, etc. who drive company business. However, it is dependent on the individual in this position to not allow the stress/work over consume daily life. My strong advice is not to go into this position thinking it is low stress. Instead think about, what will you do to balance work-life?

Also, will this be your first time working in UM? If so, keep in mind you will have a steep learning curve. 1) you will have to learn the company's UM processes, claims software, performance metrics,etc. 2) if this is your first time working on the payer side, you will need to learn the "payer jargon" and have an understanding of all available health plans/member networks/it's effect on the UM process. Good luck.

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Utilization management requires computer, strong clinical, and communication skills.

You will be assessing clinical information for admission requirements. You also will be applying ALL of the company's business rules.. there's a gazillion of those. It's complicated, I had 3 months of orientation and it just scratched the surface.

I always got out on time, the rotation to weekends would be up to your employer. Some insurance companies aren't even open on the weekends. Juggling all that was stressful, but I don't think it would be as stressful as your current position.

Bonus! I worked from home.

Good luck.

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So it sounds like there is a lot to learn and probably a lot of stress while at work, but there is possibility of work life balance? Right now I never know when I will have to go into work. I went three weeks without a day off. If people don't show up I am the last ditch effort. My MDS coordinator doesn't show up about half the time and my risk manager Calls in sick a lot. Plus I never got oriented to the DON position and this is my first long-term care job. I'm pretty proud that we passed survey because this is the first time in years that this nursing home has not got a lot of substandard tags. I can handle stress, but I am not giving up my weekends anymore.

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Yes, it is possible to achieve work life balance.

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