Is there anyone out here that does remote UR review? I am a bedside nurse and want a change in my career path. I have no experience but I am equipped with my clinical knowledge which is an important asset. I bought a CPT book to try to get familiar with it. It’s hard to find a mentor or someone that is currently doing the job to get advice/guidance since everyone is working from home these days. Please tell me what to study to gain basic knowledge. Microsoft office..books????

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I currently WFH as a Utilization Management nurse. I did not have specific UM experience but I do have specialized experience in my field (Behavioral Health) and psych certification. Utilization review is mainly making sure that the patient is receiving the correct level of care and that the treatment being given is appropriate for the condition. I recommend you check your resume and experience against job postings for UM positions and see how you can make your work experience relate to that job posting. For example, I did not have UM experience but I did have experience with doing psych intake evaluations. During those evaluations, I had to determine if the patient met the criteria for inpatient admission or if they needed outpatient. Do you assist with discharge planning or prior auths? Try to edit your resume to include some buzz words included in the job listing and to show how your experience can be easily adapted to the UM role. Read up on criteria such as MCG, LCD, InterQual, etc. Most insurance companies are going to use those or something similar to determine medical necessity. Then, just keep applying to as many positions as you can find.

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Thank you for the response your provided OP- I have a MA, BSN, RN with my psych Certification. I am trying to find your exact position. I also have some experience in intake, case management as well as inpatient and outpatient- all experiences are in psych/CD. I admit that don’t know programs such as interqual- but I can learn it if I could get the opportunity- and there in lies the problem- I can’t even get an interview! Other suggestions?

Have you checked out ConnectRN?

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No, I have never heard of the site but that just changed …thank you😊.

@Registered Nurse, I'm in the same boat as you are. I currently work bedside, 5 years and now I'm ready for a change, more behind the scenes. Looking for a part time position as a UM. I'll take even low pay.

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