Utilization Review

Specialties Case Management

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How does one get started in doing Utilization review? Do you have to have a certificate and where does one get that? I have done floor nursing for many years and need to get off the floor.. Thank you..:yeah:

Typically, UR jobs only require a nurse with 3-5 years of acute care experience. I had only been a RN, BSN for 3 years when I obtained my 1st job offer as a UR Nurse. Stay persistent in your job search. Good luck!

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Thank you for the encouragement, I appreciate it!

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MD Guidelines and ODG Guidelines are also used.

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Specializes in Utilization Review.

Wanted to say in regards to experience (and maybe it's because they're short staffed) but I was recently offered an interview for a UR position with only 1 year med-surg/tele experience around the Cleveland area. Never hurts to apply to all sorts of places if they sound interesting to you!

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Me also. Done bedside for many years and time to change.

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Thanks for sharing your experience ladies!

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I may be the first one to say this but Oh well!

i started UM 6 months ago and honestly thought it would be something I thoroughly enjoyed. I thought I could grow and and love the job. I absolutely hate it. The expectations for productivity are unrealistic! In my 17 years of being a RN , I cannot recall ever being so disappointed in a choice I made to pursue another avenue of nursing . The salary is very good.. but the workload is not worth sacrificing a peace of mind. It could just be the company who knows.. but I am leaving the position as soon as I find something else. I made a mistake in thinking this would be something, a different aspect of nursing I would enjoy. I would not discourage anyone from attempting UM. It's just not for me

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I may be the first one to say this but Oh well!

i started UM 6 months ago and honestly thought it would be something I would have thoroughly enjoyed. I thought I could grow and and love the job. I absolutely hate it. The expectations for productivity are unrealistic! In my 17 years of being a RN , I cannot recall ever being so disappointed in a choice I made to pursue another avenue of nursing . The salary is very good.. but the workload is not worth sacrificing a peace of mind. It could just be the company who knows.. but I am leaving the position as soon as I find something else. I made a mistake in thinking this would be something, a different aspect of nursing I would enjoy. I would not discourage anyone from attempting UM. It's just not for me

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Specializes in Informatics; Labor & Delivery; Med-Surg.

Did you end up sticking it out at your employer? Which company was it. I just accepted a position with WellMed/UHG? Now I am kind of nervous.

Cassiern1974 said:
I may be the first one to say this but Oh well!

i started UM 6 months ago and honestly thought it would be something I would have thoroughly enjoyed. I thought I could grow and and love the job. I absolutely hate it. The expectations for productivity are unrealistic! In my 17 years of being a RN , I cannot recall ever being so disappointed in a choice I made to pursue another avenue of nursing . The salary is very good.. but the workload is not worth sacrificing a peace of mind. It could just be the company who knows.. but I am leaving the position as soon as I find something else. I made a mistake in thinking this would be something, a different aspect of nursing I would enjoy. I would not discourage anyone from attempting UM. It's just not for me

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Hi, I am sure you already started at UHG, I work there and absolutely love what I do. I have been around for a while from CNA to LPN, RN, MSN, Post Masters in NLM and starting FNP in March. I would not change doing UM, I love it. I work from home and save on gas, traffic, lunch, getting dressed, etc. I tried another well known insurance company for concurrent review inpt and absolutely hated it. Every insurance company is different. I plan to retire from my employer, the benefits and pay are great. I also do UM but not for an insurance company on the side and also from Home. What can I say? the jobs for RNs are endless and a blessing, hard work yes but worth it!

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I think it depends where you work but yes my second job is all about productivity and quality and high call volume but it beats working in an office. I could no longer do bedside, I love patient care but after starting as a CNA at 18 years old, then LPN, and RN bedside over 7 years, it was time to go. Yes, you are on the phone but not all the time but you will be typing and navigating different systems. I tried one huge well know insurance company, THE WORST EXPERIENCE in my life. I am glad I got out in 2 months, and that was because I grabbed the PTO I had earned LOL.

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Yea,

I think it depends on the employer but 1 year in Med/Surg is a lot of work and organizations should consider hiring nurses as we worked hard to get our licenses!

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