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Utilization review nurses

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by URnurse1988 URnurse1988 (New Member) New Member

1,238 Visitors; 10 Posts

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6,486 Visitors; 338 Posts

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!

Do you work for an insurance company? If so what type of work do you do? I work in disease management and it looks like more off shifts could be required. I'm ready to look into other areas.

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650 Visitors; 3 Posts

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.

There are a few different avenues you can take with regard to UR positions with insurance companies.

1. Use a Administrative RN recruiting agency in your area

2. Google to find insurance companies

3. Google companies that are contracted to represent insurance companies

4. Job boards

UR can be onsite or telephonic. Some companies have "field" UR RN's that cover designated hospitals.

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1,039 Visitors; 13 Posts

Is there a possibility of doing this as a part time work. I already work full time in a small drs office, but my boss is looking to reduce hours so I would love something that I can do on a part time basis. I like the sound of the reviewing - I have 23 years of experience which should help!

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650 Visitors; 3 Posts

Yes, you can do part time utilization review. Companiew who manage state medicaid programs use RN's part time, TPA's sometime have part time positions as well.

The reason I have some knowledge is because I am an RN recruiter in Arizona. I work on the administrative - full time positions in insurance, hospitals and TPA companies.

I hope this helps. You can google to find these companies in your area.

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1,353 Visitors; 24 Posts

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?

3-27-07

Hi! I just came across your post and was wondering if you ever followed through with this company? I, too, live in MA and am looking to get into the UR field.

Thanks for any info.

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2,774 Visitors; 45 Posts

I just did a telephonic orientation with Unival. I have to take the test and then get started. I also do assessments for several companies: CHCS, LivePlans and Care Scouts. I have to get my application/etc into Nurse's CareLink, ExamOne, PortaMedic. There is also Long Term Care Alliance.

It took forever to finally discover these places on the internet. Just had to search and search and search, but it paid off.

If anyone hears of a new source, please let me know. Thank you.

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763 Visitors; 4 Posts

Hello,

Does anyone know of any companies that have home-based telephonic review or disease/case management? I have been a nurse for 33 years and have extensive CM/UR/HMO experience. I just took McKesson's CPHC exam. I am a Director of Case Mangement, but I am tierd of the management end.

Thanks! Star :nurse:

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vlntrnurs has 15 years experience.

3,566 Visitors; 88 Posts

Hello,

Does anyone know of any companies that have home-based telephonic review or disease/case management? I have been a nurse for 33 years and have extensive CM/UR/HMO experience. I just took McKesson's CPHC exam. I am a Director of Case Mangement, but I am tierd of the management end.

Thanks! Star :nurse:

Here are some telecommuting positions.

http://www.fonemed.com/jobs/index.html

http://www.callcarenet.net/careers.asp

http://www.shsinc.com/location/work_at_home_jobs.htm

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smir953328 has 31 years experience and specializes in NICU, Psychiatry, UM, CM.

3,298 Visitors; 71 Posts

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

I have been working in the medical management industry for 8 years. Started out as a UR nurse for a small TPA, then starting training new employees as an extra duty. Did Level 1 CM for about 6 months while still training new employees. Became the UM supervisor + trainer. Both became too much to handle as the company continued to grow, so I stayed with the training aspect and focused on developing a full new employee orientation program. I did the training for about 5 years. After going through two buyouts and larger corporations taking control, I went back into the UM world and currently is a supervior for one of our five locations nationwide. I am trying to juggle work (50hr/wk), family, school. I think I am close to burnout and thinking of giving up my UM position which I really enjoy.:cry: I can't do school and work those crazy hours with a 2 hour round trip commute to boot.

Sorry got so long winded.:vlin:

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574 Visitors; 2 Posts

I am an RN with ICU experience. I injured my back and currently on disability. I still would like to work as an RN but cant do bedside anymore. I want to take the class for utilization review but dont know where to start. can somebody please tell me where to go for the class and how long will it take to finish it? thank you so much. any info is great.

cindy

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merrymmary specializes in Peds,, Home Health, some geriatrics.

2,785 Visitors; 38 Posts

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!

Do you have good benefits and do you make as much as you would if you did hospital nursing for 18 yrs?

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10,998 Visitors; 1,301 Posts

Hi everyone. For those of you that have worked both UR and triage, which area would you choose and why?

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