Utilization Review Certification?

Hi- I have worked in hospice case management for almost seven years. I'm looking to make a change to utilization review but I'm finding conflicting information regarding what certification would best help me find a job in that area. I'm a military spouse and unfortunately we move every 2-3 years. I'm hoping to find a utilization review position with a company such as Aetna, Humana, or Cigna where I might be able to stay with the same company when we move from state to state. Any advice from those of you who have worked in utilization review at either a hospital or insurance setting? Thanks in advance!

You can telecommute with Aetna and do UR, I believe they still require you to start in office. AHH (owned by Aetna) will start you at home right away after training in Ohio. Many of the UR nurses moved to that from the CM side. Some are CCM and others are not. Ahh is very short on UR nurses presently and they started the year by requiring the CM staff to help UR during the week, they are still asking for volunteers from CM on weekends. Aetna has a significant higher pay scale across the board for nurses than AHH. This came to light earlier this year when two sister were hired, one with AHH and the other with Aetna. The one with her CCM and experience was making less than her sister with no CCM.

Have you done your own UR as a hospice CM? That will be a big advantage if you have. They use Milliman, plus internal guidelines.

I do complex catastrophic CM and do my own UR on those cases.

i want to take this opportunity to thank your family for their service to the country! I know that it is not just the enlisted person that has to make sacrifices.

Thank you for the message & info! I have heard that AHH pays much less than Aetna. I may stay in hospice a while longer and get the CCM

Hi- I have worked in hospice case management for almost seven years. I'm looking to make a change to utilization review but I'm finding conflicting information regarding what certification would best help me find a job in that area. I'm a military spouse and unfortunately we move every 2-3 years. I'm hoping to find a utilization review position with a company such as Aetna, Humana, or Cigna where I might be able to stay with the same company when we move from state to state. Any advice from those of you who have worked in utilization review at either a hospital or insurance setting? Thanks in advance!

Hi,

I'm not sure if you've found anything yet, but look into Anthem (A.K.A. Blue Cross). Many of their positions are FT WAH (work at home). I started as WAH immediately. Your position also travels with you with no problem as long as you don't leave the US.

Do you have a link for AHH? Thanks