UR ins and outs

[rummy2]

I just accepted a new position as a utilization review nurse. It is in a small rural hospital. This is my first time at UR. However, I have had years of discharge planning experience from my first career as a social worker. I have now been an RN for about 8 years and have worked primarily on the floor in many different areas. I am looking forward to the new job b/c I really enjoyed CM and discharge planning. Not sure about the differences I will encouter doing it as an RN this time around. I was hoping to get some feedback on what to expect in the UR role including the pro's and con's - Thanks!!!!!

[d'cm]

Where I'm from (NJ) UR in an acute hospital usually means providing daily reviews to the insurance co (HMO) nurse and writing appeals for the days they deny. You will need to know admission and continued stay Criteria usually InterQual or M&R. Having done UR work for several years, I found that you need to learn to look at cases from medical point of view rather than a nursing. M&R is a great reference if you can get your hands on it (it is outrageously expensive)

[rummy2]

thanks for the feedback. I will be using both milliman and interqual - depending on the floor. I was reading other posts and it seems like everyone is looking for refence material on these programs. Doesn't the hospital provide training on how to use the programs? I know that we can access both milliman and interqual through hospital computers. I just thought they would provide training about how to use it as well....

[d'cm]

... yeah you'd think, ...but you aren't going to kill anybody if you use it wrong. You'll find InterQual is pretty easy, just get used to the fact that a significant percentage of pt's will not meet. Ultimately you only have to answer one question: " why does this pt need to be in a hospital?" Milliman works well for surgical and is kinda simple: Afebrile, passing gas, advancing diet - adios.