Utilization Management LPN/LVN Salary Question ...

kjg1 · May 1, 2008

I have worked in Utilization Management for the last 14 years. I am an LPN. Usually these positions are salary, not hourly. Just starting out Try to get 43,000 settle fo 41,000 if you have to. Find out what their offer is first. I am from PA.

Karen

Midwest4me · May 2, 2008

What exactly is meant by utilization management?What tasks are involved in such a job?

caprisonne · May 2, 2008

What exactly is meant by utilization management?What tasks are involved in such a job?

Aloha!

Utilization management is a forward looking effort to manage health care cases efficiently and cost effectively before and during health care administration ... which is not to be confused with utilization review which is a more backward looking effort considering whether health care was appropriately applied after it was administered. To be a little more specific, utilization managment was explained to me to be a program which is the first step in monitoring and controlling the way a benefit plan is used ... enabling the benefit provider to ascertain the medical necessity of the services a patient may receive, ensure that the treatment is the most appropriate and cost effective, and most importantly, be able to identify high risk and high cost patients early on.

This is the job description they have:

Job Summary:

Conducts Medical / Surgical medical necessity reviews. Compiles information needed to process prior authorization requests and documents in the medical management system. Prepares and presents cases for Medical Director review. Refer cases to Case Management and Disease Management as appropriate. Identifies needs for process improvement and recommends changes. Advises non-clinical staff on clinical and coding questions.

Key Responsibility Areas:

o Conducts prior authorization activities and referral management activities.

o Assesses medical necessity by screening available information against established criteria, using InterQual Clinical Guidelines, Clinical Decision Support Tool, and Behavioral Health criteria. Ensures timely reviews for requesting facilities and notification to parties.

o Conducts care coordination activities and post-service nursing calls.

o Refers cases to Case Management or Disease Management for review as appropriate. Prepares cases for Medical Director and Peer Review.

o Coordinates discharge planning and completes necessary authorizations.

o Researches and collaborates with appropriate community resources to support discharged beneficiaries.

Hope that helps!

c.

Midwest4me · May 2, 2008

Aloha!
Utilization management is a forward looking effort to manage health care cases efficiently and cost effectively before and during health care administration ... which is not to be confused with utilization review which is a more backward looking effort considering whether health care was appropriately applied after it was administered. To be a little more specific, utilization managment was explained to me to be a program which is the first step in monitoring and controlling the way a benefit plan is used ... enabling the benefit provider to ascertain the medical necessity of the services a patient may receive, ensure that the treatment is the most appropriate and cost effective, and most importantly, be able to identify high risk and high cost patients early on.
This is the job description they have:
Job Summary:
Conducts Medical / Surgical medical necessity reviews. Compiles information needed to process prior authorization requests and documents in the medical management system. Prepares and presents cases for Medical Director review. Refer cases to Case Management and Disease Management as appropriate. Identifies needs for process improvement and recommends changes. Advises non-clinical staff on clinical and coding questions.
Key Responsibility Areas:
o Conducts prior authorization activities and referral management activities.
o Assesses medical necessity by screening available information against established criteria, using InterQual Clinical Guidelines, Clinical Decision Support Tool, and Behavioral Health criteria. Ensures timely reviews for requesting facilities and notification to parties.
o Conducts care coordination activities and post-service nursing calls.
o Refers cases to Case Management or Disease Management for review as appropriate. Prepares cases for Medical Director and Peer Review.
o Coordinates discharge planning and completes necessary authorizations.
o Researches and collaborates with appropriate community resources to support discharged beneficiaries.
Hope that helps!
c.

Thanks for such a detailed explanation--that really helps! It sounds interesting.

just1, MSN · May 14, 2008

Find out what staff nurses in your area are making and take it from there. I worked in UR in the mid-90s, made $4000-5000 less per year than staff nurses supposedly because we worked no weekends/evenings/holidays, no lifting or exposure to body fluids, etc. I had surveyed multiple hospitals across the country at the time and found this to pretty much be the trend. It was a good job and I enjoyed it, even at the lower salary.

HaydenK808 · Dec 12, 2008

Find out what staff nurses in your area are making and take it from there. I worked in UR in the mid-90s, made $4000-5000 less per year than staff nurses supposedly because we worked no weekends/evenings/holidays, no lifting or exposure to body fluids, etc. I had surveyed multiple hospitals across the country at the time and found this to pretty much be the trend. It was a good job and I enjoyed it, even at the lower salary.

While at a lower salary being a RN, the position that the person is going for is for an LPN. I would think that it would be a wage increase from bedside LPN salary.

Either way I am glad you enjoyed the job switch. I know many bedside nurses LPN & RN who are getting burned out and something like case management is just the cure to maintain sanity while still working in the same organization, keeping the seniority & 401k etc.

dandalora1 · Apr 19, 2010

Terminology can get confusing from what I'm reading here.

I'm working UR/utilization review making $30.00 hr as an LPN. I'm in South Carolina where wages are much lower.

dandalora1 · Apr 21, 2010

Utilization Review / Clinical Records Review

Has anyone worked for Carecore National based out of New York, Colorado, South Carolina?

When you start out working for them, while in training, it's a non negotiable wage of 20.00 per hour.

Upon completion of successful training 3-6 weeks, your pay goes to 30.00 per hour; "once you have met established quality and quantity benchmarks for processing cases, you will be given the opportunity to work on a case-rate basis, which offers the potential for increasing your salary to as much as 125% to 150% or more of your hourly rate"

Anyone have any idea just exactly what this means? How hard is it to "reach established quality and quantity benchmarks?"

tlburnsrnbsn · Apr 24, 2010

I worked for CCN for five years. When you are first starting out the benchmarks can be a little tough. But once you do cases over and over again, it gets easier. When I first started we had to memorize the criteria for each study. lol. They have a different system now, a lot easier. What worked for me was studying the guidelines in my spare time. It really helped. Good luck.

dandalora1 · Apr 25, 2010

tlburnsrnbsn

thank you! Was wondering how that worked when they got in touch with me they had stated you start at 20.00 per hour then go to 30.00 per hour based on quantity/quality.

I will study the guidelines as well, before I start with them. Not sure where to find those online.

Can you point me in the right direction or give me some key words I can google?

I'm excited and can't wait to start!

tlburnsrnbsn · Apr 25, 2010

Good for you! yeah, sure. go to CCN website and click on criteria on the right sidebar. Then click on CCN radiology criteria. Now they use the word criteria but they are really guidelines. You can click on any test or procedure and it will give you the general guidelines. There is also oncology, sleep study, cardiology and pain management guidelines listed. Criteria is what clinical reviewers and medical directors use to make a decision on the study. And that is not public. They will teach you how to use the criteria. Take care.