What's the difference betw case manager and UR?

[ladybug847]

I am contemplating a job change. Can one get hired for either without prior experience? I would like feedback from people doing each of these jobs? Do you like what you do? :)

[SummerGarden, BSN, MSN, RN]

i am new to case management. i found a job that was willing to hire and train me, an experienced clinical rn. my job is very stressful and fast paced (i work in a level 2 trauma er and center). the learning curve is high (there is so much to learn about community resources and compatible insurance). i also am asked a million questions every second of a day regarding my patients and discharge, that this is the only aspect of the job that reminds me of bedside nursing! however, despite this i love my job!

i work in as a casemanager involved with pre-admission, admissions, observation, discharge planning, and umr. i work in a professional setting with professionals. i get to dress as a professional daily (no more scrubs) and i attend meetings, where positive outcomes are the focus rather than stupid gossip!!! by the way, like the term nurse, case management is broad.

the job of a case manager is highly dependent upon the work setting plus his/her duties and responsibilities. there are links on here where you can get a general idea of what case management encompasses and the professional role of case managers.

ur (utilization review) /umr (utilization review management) are also broad terms, but they are a part of case management rather than something separate. for instance, not all case managers are involved with ur or umr. my understanding of the differences between the two is that ur case managers do not directly work with patients and families to plan and implement interventions. rather they review and/or audit cases to ensure proper care and payment. an example is a ur nurse who authorizes services as a representative for an insurance company. the ur nurse in this case can work during the implementation process of a care plan, but the care plan is usually developed by another case manager who is directly working with the patient. again, this forum will provide you with more information good luck!

[NurseRoRo]

In the company that I work for, a Case Manager may be expected to do some UM things, but UM nurses are not expected to do CM duties. UM nurses do not interact directly with the patients/families, rather they deal with hospital Utilization Review nurses and doctor's offices. They deal with authorization/review of days the patient stays in the hospital, as well some prior authorization of services to those inpatients. Case management nurses in my company also do discharge planning for people in the hospital. We can do auths for home health services, DME, etc. And when they get home we do a case management assessment and enroll them to case management, which means assisting with coordination of care, doing med/disease education, linking them to community services that may assist them, etc. This requires a license in whatever state you get assigned to. Some companies require nurses to have a license in every state.

[CCL"Babe", BSN, RN]

Case Management and Utilization and Review can be two very distinct jobs depending where you work. UR is evaluating people essentially for SI and IS: Severity of Illness and Intensity of Service. You are assessing to see if people meet criteria for admission to the hospital, Skilled Nursing Facility (SNF) or other type of skilled care center. If they meet that criteria you are looking to see if they are getting treatments that warrant admission to whatever level of care they are going to. Discharge Planning (DCP) is usually combined with UR. Hospitals tend to call UR & DCP case management. Managed Care companies do not consider UR & DCP case management. (they can in fact be quite snobby about the differences in my experience) Case management can also be disease management, hooking people up with community resources, health teaching among other things. I highly recommend looking at the Case Management Society of America's website: http://www.cmsa.org/

[Katie82, RN]

Case Management and Utilization and Review can be two very distinct jobs depending where you work.

Also, not all CM jobs are hospital based. I am employed by the State and my job includes direct patient contact as well as Utilization Review and Quality Assurance. I have learned so much from this job, I am able to list CM, UR and QA on my resume. The bottom line for a case manager should always be quality, appropriate care in the most cost-effective manner. Says it all....