Utilization Review: Initial Review vs. Admission Review

Hi Cousins, This video is part of my Utilization Review series. We are going to discuss the difference between an Initial Review vs. Admission Review. I also have new templates that will assist you with the clinical review process.
Utilization Review Templates:
utilization-review-crew.newze...
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[@emilypatterson2995]

You explain things so well! Thank you sis😌

[@Iamcourtneynoel]

That makes me happy! Thank you for watching! 💕

[@Samelia]

HEy Court! Love this video great tips/ Information

[@Iamcourtneynoel]

Hey boo!!! Thank you so much for watching!

[@LilyWillow92585]

Hi Courtney, love your videos! do you know of any up to date, current, hospital CM and/or UR training, books, guides, terms/policy, guidelines to prepare an experienced nurse for hospital CM UR? ( I understand some facilities combine CM and UR and others separate so am asking for both) your recent video on status, inpatient vs observation was informative and new knowledge for me. Keep these wonderful videos coming!!

[@Iamcourtneynoel]

Hi there! Thank you for watching I recently did a video on dyad and triad model which may be helpful! Also The writer of the CCM exam book has courses. Which I have a discount code for: courtney10 casemanagementinstitute.com/?ref=10

[@omarisomar741]

You go girl 👌🏾

[@Iamcourtneynoel]

Thank you!!! 💕💕💕

[@KatrinaJoy225]

So this video is regarding working for a hospital/facility, but this is different than working Utilization Management for BCBS or another insurance company, correct?

[@Iamcourtneynoel]

The initial review part is for a facility. Admission review could go either way. The only difference is you would be receiving the clinical information comparing to criteria and making a determination. Still need to do your own clinical review of the information provided

[@kimberlyjordan8574]

Hi Courtney! I’m looking for the template. Can you tell me where to find it please??!

[@Iamcourtneynoel]

@@kimberlyjordan8574 Hi there here is the link! 😊 utilization-review-crew.newzenler.com/

[@ceeajay]

Hi is the template not available anymore or is there somewhere else I could find it?

[@Iamcourtneynoel]

Hi sorry just seeing this! Here is the link for the template: utilization-review-crew.newzenler.com/

[@kaitlinmasters5354]

I just got hired for ED utilization. Do you find it stressful?? I have been floor nurse for 6 years! Was ready try something new. Kind of nervous!

[@Iamcourtneynoel]

Congratulations!!!! It can be stressful but not like working the floor! A different type of stress! I always tell my preceptees when they get overwhelmed remember nobody dies and we can always fix mistakes! 💕

[@glassgloss]

Great video! But what is the difference between utilization review and utilization management? Also, are there different roles in UR? For instance, I think you said you work in appeals and denial and I've also heard some people talk about pre cert.

[@Iamcourtneynoel]

UR v UM can be used interchangeably but UR is the actual practice where as UM is the specialty. So under the UM umbrella there would be Prior Auth/Pre-cert, UR- Admissions, Concurrent, Retroactive, Denials Appeals, Billing recommendations etc.

[@glassgloss]

@@Iamcourtneynoel Thanks for clearing it up. That helps a lot.

[@reneehill8590]

So beautiful ❤

[@Iamcourtneynoel]

Thank you!!! 😘😘😘

[@peachesroyale]

I work for the Payor side doing Reviews ….never worked the hospital! I wonder how different the two are

[@Iamcourtneynoel]

Not that much different… Just a difference in process but the concept is the same. Come on to the provider side lol!

[@peachesroyale]

@@Iamcourtneynoel I should cause girl 👀

[@brit8172]

😊