Utilization/Precert Nurses

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any utilization review/pre-certification nurses out there? i have been doing this for about a year for a major insurance company and just wondered what others thought about this job. i don't think there's too many of us out there :)

Specializes in Case Mgmt; Mat/Child, Critical Care.

Thanks for the encouragment everyone. I am getting used to the different environment, the hours, etc. I was actually enjoying myself this last week, they have been letting me work 'semi-indepemdently' and I seem to be doing pretty well, still so much to learn, but it is very interesting. One of the trainers was on vacation and is due back this week and I hear we will be going back to the training room for more extensive training w/him, but, I have done so well working on on one w/another nurse, etc. I think if I have another 2-3 wks in this classroom, I am going to choke...LOL! I know, I'm gonna hang in there, it is temporary. This is starting my 6th week now, and I'm feeling much more comfortable w/the job.

I'll update more next week, have a good one, y'all...:)

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Specializes in Case Management.

My health plan is rolling out a new pilot program for the on site UM nurses. It is more case management than just reviewing the charts. We will be totallly involved in the discharge planning including speaking with the patient and working closely with the hospital case managers in transitioning the pt to the next setting after discharge. I believe it will satisfy my case management/patient contact itch and I have applied to the directors of the on site department. I think I really nailed the interview and am waiting to hear! The director told me that one of my answers to their interview questions gave her chills!! (in a good way!) So, wish me luck, I am finally going to get out of the office politics after 2 years of dealing with it!

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Sorry I am new to this..I was trying to get input from Lorelai22RN about her experiences--and anyone else.. :)

Hello--I am currently a military nurse working med/surg. I am enrolled in a MSN Case Mgmt online program--which I should complete at the time I am ending my obligation. I have varied experience as a medic over 10 years, LPN 4 1/2 years, and as RN it will be like about 4 years--when I am ready to start working as a CM. My RN experience will be Med/Surg--and a brief experience with Nursing Home. I have NA/LPN experience in Psych, Med/Surg, Pediatrics, Physical Exams, L & D.

I am replying..because you appear to be a newer nurse and working in case management. A lot of the nurses on this forum speak of many many years of experience and if not the inability to get hired. How has it been for you to earn the respect of coworkers--being young and a new nurse? I do have some experience (though not CM)--but I figure getting the MSN will help to get hired--in lieu of the experience.

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Specializes in Med/Tele.
Sorry I am new to this..I was trying to get input from Lorelai22RN about her experiences--and anyone else.. :)

Hello--I am currently a military nurse working med/surg. I am enrolled in a MSN Case Mgmt online program--which I should complete at the time I am ending my obligation. I have varied experience as a medic over 10 years, LPN 4 1/2 years, and as RN it will be like about 4 years--when I am ready to start working as a CM. My RN experience will be Med/Surg--and a brief experience with Nursing Home. I have NA/LPN experience in Psych, Med/Surg, Pediatrics, Physical Exams, L & D.

I am replying..because you appear to be a newer nurse and working in case management. A lot of the nurses on this forum speak of many many years of experience and if not the inability to get hired. How has it been for you to earn the respect of coworkers--being young and a new nurse? I do have some experience (though not CM)--but I figure getting the MSN will help to get hired--in lieu of the experience.

When I applied for this position, they wanted a nurse with 2-5 years of experience.......I had just barely a year on med/tele and I was hired. I was scared I didnt know enough but they all told me when they first came they knew nothing about precert or case management , that they learned on the job and told me not to feel anxious or intimidated, that I'd be trained. Most of my coworkers are much older and have been nurses quite a while and I did feel a it insecure at first because I only have just over a year now, I'm still PRN on med/tele........but they have all been sweet and my preceptor started out with baby stuff.........I caught on quickly. The other nurses told me that med/tele experience is great to have........I think I lucked out with this job....they needed someone to fill the position but most nurses turned it down because of the pay, alot of nurses dont get that when you leave the hospital, the pay is usually gonna be less but sanity is priceless to me and they told me that some of the nurses they interviewed didnt like the 8-5 schedule because they felt they could work 3 days in the hospital and be off 4 days and make more. I was working 3 days a week, 12's but I was so exhausted and miserable and I'm glad the supervisors were willing to hire me and take a chance, they also explained that sometimes newer nurses are easier to train and they liked that I had med/tele experience....But anyway, it's 42,000 a year which is fine with me I didnt care if it was less, I just was not feeling the hospital and I had planned to stay PRN if it was gonna be a big paycut...........it turned it to be a bit more than what I was making in the hospital full time. I feel more respected than I ever felt in the hospital.......even though I'm the newest nurse here. I have a nursing degree, a nursing license, and a just over a year of experience so.........I feel pretty confident with it.....but they probabaly would have hired one of the other applicants if they hadnt been so money obsessed.......they wanted a much higher salary. Truthfully, the more experience you have does increase your chances of getting a job like this so I doubt you'd have a problem getting a case management job......its just they are hard to find.....cause alot of people who get CM jobs dont leave!!

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thanks for your insight. I have a while to investigate further...so I'll keep my eyes and ears open. What part of the country are you in? New grads in Wa state--make ~$23/hr...base pay. The AF pays a little more than that when you count in the benefits. I have been working shift work a long time now...and well...sanity wins out over money anyday. Thanks again.

And I do have a lot of loyalty with AF/military nursing..so if anyone is curious about it...I'm here.

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Specializes in Med/Tele.
thanks for your insight. I have a while to investigate further...so I'll keep my eyes and ears open. What part of the country are you in? New grads in Wa state--make ~$23/hr...base pay. The AF pays a little more than that when you count in the benefits. I have been working shift work a long time now...and well...sanity wins out over money anyday. Thanks again.

And I do have a lot of loyalty with AF/military nursing..so if anyone is curious about it...I'm here.

I'm in LA. New grads here make about $18-19 and hour base. I was working 3-12's, days on the weekends so I was getting shift dif but I was so exhausted all the time......I'd sleep 2 of my 4 days off. I'm making a bit more at this job even though I was getting shift diff before....so thats nice. I'm amazed how many nurses will work at jobs that they dont like for a couple dollars difference more.

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I worked as a UR nurse until the company was bought out and downsized. Following that I worked oncall for a hospice agency and absolutely loved it. Unfortunately I have a nerve injury in my right foot which prohibits me from driving without much pain and difficulty walking. I would love to go bacl to UR if I can find a company that allows work from home. I live in Vero Beach, Florida. If anyone knows of any such company please contact me at [email protected] Thanks :-)

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Specializes in Med/Surg, Oncology, ER.

I made the transition from floor nursing to case management as well, I have been doing CM for a year now and the longer I'm in it the more I enjoy it. I also missed the direct patient care, I have stayed PRN because of this. I find that with each month that passes and all the stuff I see going on on the units, I'm really glad I'm not a fulltime floor nurse anymore, I get my fill a few days a month being PRN

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I am interviewing for a Precert job today w/ a big insurance company, I am excited but nervous, I really want to get away from the bedside. I too think it would take awhile to get used to the slower pace, inpatient is just dang crazy any more!!!

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I worked UM for a hospital for over 5 years and really enjoyed most aspects. It encompassed medicare and commercial insurances for precert, continued stay and D/C planning. I learned a lot covering different areas of the hospital including interviewing patients, families, working with social service, home health, and talking to doctors. I didn't miss direct patient care possibly due to the interview process and really enjoyed the hours. It was very nice to go home and not be dog-tired.

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thanks so much, had my first interview to day second interview on Wednesday, I think it would be so fun and give me a break from the bedside.

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