Utilization review nurses

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Any UR nurses out there that work for an insurance company or TPA?:)

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Any UR nurses out there that work for an insurance company or TPA?:)

Hi - I know this isn't an answer to your question but I am interested in looking into insurance companies. How do you even start to look for a job? I have 30 years in nursing (9 as LPN) in varied settings: palliative care, med/surg, long term care as medicare nurse, ADON and DON. Could you tell me what it entails? Do you work in an office? A clinic? At home? Thanks in advance for anything you can tell me.

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Hey,

You would probably be good working for an insurance company with your many years of varied experience. There are different jobs you can do working for an insurance company i.e. medical necessity reviews, pre-certification of hospitalizations, case management of patients with catastrophic diagnosis such as cancer, wellness coaching, disease management of chronic disease such as diabetes, CHF, CAD, COPD. If you currently work at a hospital, you could ask your case management/utilization review dept. if they know of any insurance companies looking for nurses. Sometimes you can work from your home. Usually the hospital case management/utilization review nurses speak to insurance company nurses everyday. You could also call the big insurance companies Cigna, Aetna or others in your area and see if they have any positions or you could just send them your resume. I have been working for an insurance company doing utilization review for the past 18 years and I don't miss direct patient care one bit. I love the Monday to Friday 9 to 5 hours. Good luck!

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thank-you so much for the information. i am ready for something that is different but important. i'm excited to do something else for a change. i'll start making calls tomorrow!

eileen

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I went online last night and went to an employment site in my area of Mass. I posted a resume and sent it to a company called UNIVAL. I was quite surprised when there was a message on my answering machine from them regarding my application. Ever hear of them?

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No, I have never heard of Unival.

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How do I get started in this? I have over 20 years in nursing in many areas. I have applied for an internal position also.

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Hi - I'm not sure that I have any valuable information but I went to a local site for jobs, found one that was looking for nurse reviewers, and applied. I got a call the next day and will let you know what I find out, ok?

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Specializes in Case Management.
How do I get started in this? I have over 20 years in nursing in many areas. I have applied for an internal position also.

I started in the managed care arena about 20 years ago. I started at the biggest insurance company in Pittsburgh. That would be the best thing to do. Ask around people you know what insurance do you have. And find the biggest in your area. The biggest companies are not necessarily looking for past experience, they expect to train you.

I have moved around through almost every company in Pittsburgh. I worked UM, case management, population management, on site reviews, telephonic reviews. I did some prior auth and had some experience with TPA's and self funded companies which is a little more challenging.

The company I work for now is associated with one of the largest universities in pennsylvania. They have a medicaid product which is the department I wok in now. (I always look for new experiences). I left the hospital after burning out and almost losing my sanity! (see nursing ghost thread)

I don't regret leaving floor nursing. I hated evening and night shifts and working weekends and holidays. Once you get some experience you can make some good money in this arena.

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This seems something to very interesting, thanks for posting itMartRN

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I work in UR for Blue Cross/Blue Shield. Check out your locals website.

I heard Cigna is great to work for.

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Does anyone have names of TPA (third party administrators) who contract with insurance companies to do in-home assessments for long term care clients? Thank you. Vinda

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