What is it like going from med/surg to UR (no case management)?

d'cm · Jan 14, 2011

Pure UR can be a bit tedious. You open a chart, document severity of illness, intensity of service, apply criteria, make a referral if it doesn't meet, call or fax insurance company, update authorizations. Do it again. Rare patient contact. Stress is minimal compared to M/S and almost always regular hours, no weekends, no holidays. ( or overtime).

Genista, BSN, RN · Feb 11, 2011

Thanks

KaroSnowQueen, RN · Feb 11, 2011

One word: WON - DER - FUL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Genista, BSN, RN · Feb 17, 2011

Karo-Snow-Queen- I pm'd you. Thanks! :-)

gr8rnpjt, RN · Feb 27, 2011

I left bedside nursing after 8 years of solid Medsurg/Tele experience. I have always worked for insurance companies, but have done every imaginable type of UR/CM nursing. I worked onsite at hospitals, worked in office settings in a large metropolitan market. I did CM jobs and UR jobs and eventually found my niche in UR. It is a great job. I love the hours the pay and I am currently working from home. I telecommute, all my coworkers work from home and we have daily call in meetings. The company I work for has gone through many changes all good. I would recommend any job CM, DM (disease management)or UR job. When you get your foot in the door, you can go practically anywhere within the managed care arena. Managed care is not going away, even with universal health care. I have a couple of suggestions.

1. take any UR or CM job you can take. You wil get your foot in the door, and you will be able to transition more easily to another job if you find UR boring.

2.Subscribe to CM magazines to help you figure out the whole process. You will get a feel for what is expected of you.

3. once you decide, work on obtaining CM or CPUR certification. It helps get the better jobs out there. (I was a diploma nurse with a solid skillset for bedside nursing.) That is what they want. But once you start working in this arena, certification gives you a leg up on the competition.

4. The job will keep you informed on new policies and practices in the hospital nursing world. If something comes up during a review that you don't understand (a new piece of equipment, or a new lab test, ask your counterpart at the hospital for more information. They will be happy to help you understand.

5. The CM world is forever changing and evolving. Be prepared to grow and change as your responsibilities grow and change. Remember change is good.

6. Remember that your job is very important. It is different from bedside nursing but it is an important function just like any other job in the nursing field.

I can't think of anything else right now, but I would be happy to answer any questions you have. I have worked in every company in the the big city I work near. I have done every CM/UR job there is. I have been in managed care for 22 years. I am not sorry I did it and every job I have left was for a better job. I would not trade the one I have for anything. If I want to sleep till 7:45, and start work at 8 in my jammies, I can. If my kids have a snow day, I don't have to worry about day care. I have all weekends and holidays off, I don't wear a uniform, and neither do I have to dress up anymore. Jammies or sweats are my dress du jour, and I love it. I make more money than I ever expected in this job, and the peace of mind and lifestyle is the best I have ever had. There is stress, but it is nothing like the stress of bedside nursing (which I remember fondly). Good luck if you decide to take this new job.

Genista, BSN, RN · Mar 1, 2011

gr8rnpjt- Thanks for all the info! I sent you a pm as well. ;-)