VLOG| Day In The Life| Utilization Review Nurse

Hey y’all! Spend the day with me! Hope you enjoy! ✌🏾
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[@sheridancrane6666]

Elderberry syrup...yes. plus all the other stuff. I try to remember to get my vitamin c, d3, zinc and selenium daily. And when I have time to make it, my crock pot fruit juice (grapefruit, lemon, lime)...yum!

[@kdenise305]

Hi 👋🏽I'm also an UM Reviewer since 2014 and remote since 2015 processing Outpatient prior authorizations. I love it; it's a different kind of crazy. It can be mentally taxing. Since I am remote I try hard not to bring the mess into my environment. Stay BLESSED BLESSED 🙌🏾

[@dopenursingish827]

Hey!!!!! Yes!!!🙌🏾 You’ve been doing UM for a long time! You’re right, definitely can be a lot mentally but definitely rewarding! The ability to work remote is a major plus! Thank you so much for your support! I truly appreciate it💕 You’re doing the right thing, leave work at work! Too blessed to be stressed! Stay blessed as well! 🥰

[@Ladybug8899]

I worked as UM nurse permanently from home. And I love it!

[@dopenursingish827]

That’s great to hear! 🙌🏾 That’s an amazing perk when getting into utilization.

[@peachesroyale]

I start 2/27 on the Payor side….pray I like it

[@reneerandomtopics]

How did you get the job? I am currently seeking a position. Looking for a company to assist with on the job training.

[@peachesroyale]

@@reneerandomtopics I worked as a CM for a year and 5 months and a position opened in my company so I applied and got it

[@sheridancrane6666]

just found your channel today. Lot of good info. I'm looking into getting into UR/RN work from home. Staffing is an issue so many places. Where I work its bad. Always so short staffed. They offer bonus and even double bonus, still can't get people. Its terrible.

[@dopenursingish827]

Hey! Yes staffing is definitely an issue! Now they have cut the rate for travel nurses so it has worsened. You should definitely look into UR. There are a lot of perks! Thanks for the support! ❤️

[@olgagiles5773]

Thanks for your video. Honestly, I can't recall meeting a UR nurse in the ER. Once we find a bed, report is called and the patient is transported to that particular area with RN/RT, etc. My question is, if a patient is admitted, what are your documentation responsibilities? Since the RN and MD basically provide detailed info, are your duties limited to CPT codes, etc? Which certifications would you recommend? Thanks in advance.

[@dopenursingish827]

Thanks for the support! Not all hospitals have UR nurses in their ER. It’s more of a improvement of communication with the MD and having the ability to discuss face to face. Our duties include reviewing clinical and criteria to determine the appropriate billing of the patient, inpatient vs. outpatient using specific guidelines. We document the clinical that is needed for insurance companies to justify inpatient vs. outpatient. You don’t need a certification for utilization because I didn’t have one. Having acute care clinical experience and willingness to learn is all you need. I hope this helps! 😊

[@olgagiles5773]

@@dopenursingish827 Thanks so much for your insight and support. You are the best!!

[@emmaafriyie5170]

I do work for a managed care organization for a New York health plan. I do utilization management reviewing prior authorization (reviews are for outpatient reviews). It is a lot of work. I work from home but it is exhausting. You get about 15 cases a day reviewing all kinds of cases: DME, home health, preplanned inpatient, office visits, PT/OT/ST. If it is outpatient and it comes in you are reviewing. I love WFH because I do not deal with anyone but you are still monitored as your computer signals if you are away. If you enjoy sitting at your desk all day, working loads of cases with different criteria, then come right ahead. Cases assigned to you are yours for ever until it gets done. You can not pass it on to another shift. There is always need for people so if you are interested please apply.

[@dopenursingish827]

Hi Emma! You are absolutely correct! The plus of the job is being able to work from home. Thanks for your detailed explanation!!

[@Citygal01]

I’m in NY too what is the name of the company? Thank you

[@Curious_gen]

I would love to come on right ahead. Where do we apply?

[@shaylajfields]

do you ever have the option to WFH? thanks for sharing!

[@dopenursingish827]

At my current place of work we do have staff that works from home in the evening and overnight. I work from home sometimes but mainly in the office. There are many utilization jobs where working from home is permanent.

[@taraspeaks6293]

As a case manager J am very interested in becoming a utilization review nurse ? Thoughts..... also is there any specific training or certification I would need ?

[@luxuryparkla9244]

Hi lovely, on average how long does each review take? I just got offered a position in UMR at a 300 bed community hospital. I'm having trouble finding out what the workload is like.

[@dopenursingish827]

Ooo 300 bed is pretty big! But in an 8 he day at my institution, the UR nurse is expected to get about 30-35 a day. But 35 is a heavy load. If it’s a new admission it takes about 15 mins but if it’s a continued stay about 5 mins.

[@Ladybug8899]

Our UM workload is 50 reviews per 8 hours

[@msdevon311]

Is working PRN an option in this field?

[@dopenursingish827]

Yes definitely! It’s more PRN opportunities in the hospital setting with utilization.