UR for insurance company?

[NurseMegP, BSN, RN]

Hello all,

This is really a utilization review question more so than case management.

I currently work as a UR nurse for a MCO in Ohio. This is only worker's compensation so I don't know how different doing UR for an insurance company would be. This MCO is small but does well. We are about 60 employees and my department is 5 people (1 supervisor, 4 UR nurses). I love this job and the work and the people. It's 6 minutes away from my house. Next week, I have an interview with a bigger insurance company for the position of Utilization Management. I don't know all the details yet on what the job entails, but this position would be in a downtown area, have a longer commute (about 30 minutes with traffic on a good day), and be for a large company. I was told in the phone interview that after about 1-2 years there is potential for work from home which is really the only reason I want to leave my job now. I have a 5 month old son and as he gets older I keep thinking how awesome it would be for me to just be able to stay home on days he is sick or school is cancelled in the future. Right now he stays with his grandma all day so it's not a bad deal either way because she loves watching him and I am comfortable that he is with her.

My husband and parents both encouraged me to at least interview with this bigger company. My main thing is that if I want to advance, as I said, my current company is just too tiny for there to be any upward or sideways movement. If I work for a bigger company, I have that opportunity potentially and eventual work from home.

Does anyone do UR/UM for an insurance company? Do you enjoy it? Can you give me a general idea of how the process works with private insurance?

Right now my day consists of treatment requests, approvals/denial appeal management, education, working somewhat with billing, staffing with CMs and claims analysts. It's pretty laid back. I'm very organized and independent with my work although I do share an office with a person who I'd now call a friend and she and I often bounce ideas off of each other or talk cases through together and I do think I'd miss that.

[Been there,done that, ASN, RN]

You are already qualified for remote positions. Market yourself.

If you are working from home, you will sign a contract that you will not be providing childcare. You cannot do two jobs at once. If you need to collaborate, you would be just a phone call or email away from your colleagues.

[NurseMegP, BSN, RN]

Hey been there, thank you for your response. I ended up having an interview with a bigger company and I would have had the ability to work from home in 1-2 years but the catch was I would still have to go downtown (10 minutes from my house without traffic, with traffic it's closer to 40 minutes) anywhere from 1 - 4 days a week so I'm sitting comfortably at my current job still.

I didn't think about a contract, I mean I definitely wouldn't be providing childcare outside of my own kids but I figured when he's old enough to self-entertain (I'm thinking like 8 years old+) that I'd just be around and he could do whatever he's into at that time.

Thanks again for the insight. Definitely keeping an eye out but I'm lucky where I'm at too.