utilization review

[kimmykng]

what does a utilization review nurse do?

what about career advancement/prospects in that field?

what do they usually make?

thanks!

[Wren]

kimmykng,

Sorry that you haven't gotten an answer yet. I have worked in UR but it has been awhile. Most UR nurses work for an insurance company/health plan or state program. They receive a request from a provider for a patient to have a service (surgery, in-clinic procedure, out-pt therapy, etc). The nurse reviews the request for medical necessity and whether or not the patient's insurance provides a benefit for the requested procedure. Most places use one of two guides (InterQual or Milliman and Roberts) to review by. So if a procedure "meets" the guideline in InterQual...the nurse approves the request. If if doesn't meet the guidelines then the request is often referred to a supervising physician. It is actually not as boring as it sounds! :)

I don't know what the current salaries are but I do think that career advancement is fairly good but that is depending on where you want to head from there. :) Good luck!

[kimmykng]

thank you very much for your response.. i'm starting my UR career now! still getting used to it.. but i lke it so far.. especially the hours! no weekends, holidays, PTO's.. :) :) :)

[URanurse]

I worked UR for two years and that was three years ago. To make myself more marketable and return back to UR, I want to take the CPUR exam. Have you taken the CPUR? McKesson offers a self study course for $150. I was wondering how fast I could take the self study if I actively pursued it? Can I buy the study guide cheaper somewhere else and McKesson still recognize it? Thanks.