- Concurrent Review Instructions
- Utilization Review Nurse Interview Questions and Answers | Clinical Review Nurse
- Is Utilization Review difficult to learn?
- What is Utilization Review? | Nursing away from the Bedside….
- LOCADTR Concurrent Review Module: A Clinical Conversation
- Day in the life of a WFH Utilization review nurse + applying for job| Nurse VLOG
- How To Interview For A Utilization Review Nurse Position
Concurrent Review Instructions
hi everyone hope everyone is doing well,this will be a tutorial on our,concurrent review,process some of the information may be,old to some folks some of it will be new,but im asking that everybody uh,reviewed a video from beginning to end,just so you wont miss out on any,information,ultimately providers are responsible for,ensuring that they are following the,concurrent review process,so prp services are only authorized,for six months before the six month,period is,has expired there is a need to do,a treatment plan meeting or a concurrent,review meeting,however you want to call it with your,client,this is the opportunity for you and your,client,if you want to invite the therapist you,can as well but this,isnt a time for you guys to explore and,to assess,whether continued prp services is,necessary or warranted,this means that there is still a medical,necessity need,so this means that there are still some,symptoms um behaviors or mood or some,type of,the rehabilitative goals that the client,will still like to achieve now if after,youre meeting with the client,you both agree that prp services are no,longer warranted,or you guys are leaning towards that,please the next step is to have a,conversation or meeting with your,supervisor,to inform them of the reasons why of,on the pending discontinuation of,services before the client,will be discharged from prp,but again you have to really um,be sure that the client has a medical,necessity need and this is the reason,why we need to continue prp services,now if after your meeting with your,client and again youre going to take,the time out during this meeting to,actually complete the clients,treatment plan review so again if you,both agree that they should continue prp,services,then the next thing you would do in that,session is to complete the,the treatment plan review with your,client now when you go,into the emr system to do that,youre going to come here to create,treatment plan and,start the new treatment plan review now,if you already have a treatment plan in,here which you should,you your long-term goals and your,short-term goals will populate,there are some areas such as the need,and the strength,that will not populate and the consumer,statement does not populate,as well if after six months youre still,working with this client,there should be some type of adjustment,needs may have changed problems and,symptoms may have changed as well,um their strengths and your skills will,may have also changed so you need to,make sure that this information is um,upload,um indicated here and also in the,sections where it says the,progress actually let me go into a,treatment plan,making sure that these sections the,progress with the goals are,measurable making sure that there are,some if there is information in regards,to,the clients behavior the clients mood,and just giving us an update on all of,the long-term goals,and all of the short-term goals so this,section should not be a one sentence or,two sentence or even three,this should be a thorough update on the,progress,that the client has made for the whole,five,months or so that the client has been in,the prp services uh the state and optum,are will scrutinize this documentation,because we actually have to,upload this treatment plan in,our authorization request in order for,us to get approval,so during covert 19,okay so let me actually back up once,youre done,creating the treatment plan review,youre gonna go ahead,and share this document with your client,if your client has a um electronic,accessibility youre going to share it,with them,and during your session and,they will see that the document will be,here on the treatment plan,so under pending treatment plans the,treatment plan should be here where they,can just go ahead and select the plan,and electronically sign off on it now if,your client does not,have the ability to electronically sign,off on their document,and please lets encourage them to do,that because we dont want,too much paper going in and out what you,would need to do,is print this form well you just make,sure that your you have your signature,here as a provider,youre going to print this form out,and youre going to print out the form,and then youre going to write here,that due to covid signatures were unable,to be obtained,so again in this section anywhere here,youre going to physically write,that due to covid physical,signatures were unable to be obtained,optum is acceptance for now temporarily,as long as we have were under the,emergency orders,and were under the uh pandemic of code,19.,once you write this information here,youre going to go back to the clients,chart,and then youre going to go ahead and,upload that document here in the stored,document section,okay so this is the process of,a treatment plan review,the next form that needs to be completed,in the emr,system is the concurrent the optim,concurrent form,so once you are here,once youre in the clients chart youre,going to come here to create,go to general note,and then either complete the minor,concurrent form,or youre going to complete the adult,concurrent form,this form again is required by,optum these are the questions theyre,going to access to get the,authorization if you do not and just,make sure that,we have enough information here to get,the authorization,if theres any section or any questions,that you guys need clarification on,um please let us know because its,important that we know how to answer,these questions,so we can get approved the first time,around because optum is taking about 14,its like a 14 day turnaround time for,us to get,a response on either an approval or a,denial,so just make sure that these these,questions are being answered,thoroughly and again it shouldnt only,be just one sentence we should see a,couple of sentences here,and evidence to support why they meet,these particular criterias so only if,youre answering yes,is when we need an explanation a,thorough explanation,of their ability to perform certain,things in each of these sections,so once youre done with that youre,going to just go ahead and save it,and then were able to upload this,information in the optum system to get,our authorization,okay so we covered the optum concurrent,form,we also covered the,treatment plan review and so the next,documents that will need to be completed,by our client,are some of the intake forms,so again we want our clients to sign off,on these forms,electronically if for whatever reason,the client does,not have the capabilities to,electronically sign off on,the forms we would need to have them,sign off,on the physical form so we,you guys will get a folder with all of,the prp forms,um it is called it is called,the concurrent documents form so this is,a physical form that you guys should all,have or you guys will receive this,document,in a folder so you guys can always,easily,have the accessibility to you know have,accessibility to these forms,so they can fill out these forms,electronically and when they,complete these forms electronically,again you guys will need to upload these,documents here,in the store document section however,im going to show you guys how to share,these forms with the client,electronically so the first form um,in on this document is the inform,consent,so when youre in the clients chart,what youll do is come here to,create come down to share,intake note,and then youre going to come to the,form that we need to to share with foot,to the client so the first one is the,inform consent for treatment,once you select that form youll come,down here youll share it with the,client,once you share that with the client they,will have it in the client portal for,signature,the next form is the,authorization to release so were going,to come,to the client port on the emr system,come down here to share intake form,look for the next form that needs to be,sent out to the client,which is the authorization to release,form,then youre going to scroll down and,share it with the client,and
Utilization Review Nurse Interview Questions and Answers | Clinical Review Nurse
hey guys whats up Daniel here and,youre watching the nurse photographer,whats up nurses those following my,journey I started working in a BPO,company as a utilization review nurse so,if youre also interested in working in,a bbo company,um you can use this website the um,indeed Glassdoor,job Street monster and Linkedin by the,way Im not affiliated with those pero,you can see the job listings in those,websites,um also look I have a new mic,um it is the hyperx solocast but Im not,using this right now because I dont,have the right cord to plug it to my,camera so like right now Im using this,shotgun mic by Boya its a vlogging a,mic but right now Im using it for for,this okay so anyway,um before I share tips on how to answer,the interview questions for the,utilization review position case,management case management position,lets talk about the salary first so,usually it will depend on the company,and their clients iOS and if you search,some websites because it would range,around 50 to 70 000 and some would also,go high as 80 000 in basic but always,remember that the higher the basic the,higher the taxes okay and also that 50,to 70 000 range,um,I will talk about more about the salary,and incentives or benefits,videos because I want to focus this,video interview questions so as we all,know that one of the hardest part in,finding a new job is at the interview,okay its the most excruciating part,um there is a um two job interviews,usually,bpos for USR ends I dont know,um accounts,but yeah were going to focus on USR and,jobs and usually it is only the initial,and final interview and some might even,require tests but usually so,um Im here to help you answer those,questions and hopefully job interviews,for these,um BPO USR and jobs by the way what Im,going to share is based from my,experience from applying to different no,BPO companies here in the Philippines,and,um the questions might vary from company,to company,but what Im going to share is the usual,questions that most of them will ask all,right so I dont want to keep you guys,waiting,usually the interviews will be done,through online and phone calls so,usually pack online via Zoom or,Microsoft team depends a company,and then so basically lets start with,the initial interview so initial,interview,um they would usually just ask no,um for your credentials um usrl license,more and PHR and license,and when is the expiration date and also,they are also interested to know what,state you pass your NCLEX because for,example one company is better than,company a will Im only Creator nurses,from New Mexico or Illinois and then if,you apply,Im from Texas and they will um shoulder,the endorsement from Texas to New Mexico,Illinois,shoulder the expenses also they are,interested in knowing the expiration,date because if its expired third they,will shoulder the cost of the renewal of,your license and the CE units so win-win,situations,all right they would also ask for your,um nursing experience,um and also its an advantage if you,have a experience in the BPO company at,least six months but not necessarily,because in the um in the company where,Im working,my experience bbo and then the rest,um some accounts they know I would,prefer like one to two years of bedside,or ER experience or kahit mix mix,language and again Advantage Pokemon bbo,experience if for example you dont meet,the requirements the number of years in,a hospital,they will usually put you or assign you,in accounts that dont need,um bedside experience so thats for the,initial interview and then lets start,with the final interview,okay for the final interview these are,usually the questions that they will ask,okay this one and another more questions,by here,okay so lets um discuss them one by one,so usually,um the first question they will ask you,is tell me something about yourself,um just be yourself no,um also it would help if you,um make a script now to answer this,parallel you dont get caught off guard,no you know what you will say and one of,the advantages of having a online,interview is you can have your um laptop,in front of you and then you can just,read no with feelings,with feelings,so first off now when they ask you first,is,like tell me something about yourself,so like first sir I would like to thank,you for giving me this opportunity to be,interviewed for this nursing position I,finished nursing back in,in school and after a year I was able to,practice nursing in this government,hospital it was a good experience to,establish establish my basic nursing,knowledge and then after a year my,contract expired I worked in a BPO named,for six months and then I studied for,culinary arts or photography,and then,um lets go to the set to the next um,question,approach is tell me something about,yourself that is not included in your,resume so like,um youre gonna answer this as a someone,coming from a suguro family of doctors,or med tech or nurses,[Music],I would like to thank you for giving me,this opportunity to,um be interviewed for this nursing,position,um I came from a family of nurses I,lived with my sister suguro no or,grandmother or parents and I believe,that,um learning does not stop in school that,is why I have a lot of books here in my,room and I kept on reading a lot of,books to improve myself and I also like,to learn new skills from time to time,that is why I learned or enrolled myself,in culinary arts or photography so from,that at least Im giving you an idea,um,just be yourself no,um,and then another question the next,question is why did you leave your last,job no why did you leave your hospital,experience,um,[Music],like I had to take care of my,um Lola or Lolo because my siblings are,already in the states no Im the only,family member here in our house,during that time thats why I was forced,to leave my previous job,and another approach for this question,is um you can say that,um,no parang,you like your job in the hospital but,um I dont think that its safe to,practice nursing,anymore,um,number of patients uh,[Music],dont say those,weeds okay next question,um,why should we hire you or what can you,contribute to us advantages,um just to give you guys an idea,I will be thorough in my Approach and,assessment with the documents that are,files that I will work on,and I am able to follow the I dont know,company rules,rules and regulation of the company,is,a company so from there I think,um,um,as a person so,its just to help you guys give you guys,and at least,no um an idea on how to answer them,um,the next question is,what is your weakness,um,is public speaking so it doesnt matter,if its a group of five or ten people no,I still get uncomfortable and to,overcome this I started a YouTube,channel and a video podcast about,and up to now Im up to now Im still,developing and improving myself in,public speaking skills English,[Music],um,why go back to work in a UR or,BPO company,um,[Music],foreign,[Music],[Music],um,bedside nursing no I you want to explore,you know other fields in the BPO,industry so were gonna know again,[Music],um,okay um next question is how do you,handle stress,hospitals,okay sir I handle stress in a couple of,ways first is I stop whatever Im doing,I pray and then second is I exercise no,because running helps me focus and,prioritize on the things that I need to,finish now or to,um yeah to finish and um lastly,um you can add this no I spend time with,my family I spend time with my friends,or I spend time with my lovely wife,again make a script,with feelings,okay next question is one of the hardest,questions now,um how do you handle a rude supervisor,so for me I think this is one of the,again the hardest questions to answer I,think you will have to research on this,okay,I believe that um or I think that each,of us humans are fighting a battle that,we only know,um and I always think that the per that,person or supervisor might have problems,so I always try to be understanding,um if theres still a problem or a,conflict I would approach I would,app
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Is Utilization Review difficult to learn?
hey whats up guys welcome back to the,nursing Channel so on todays video Im,gonna answer Julie Bonners question and,Julie Bonner is one of my subscribers,who commented the question is,utilization review difficult because she,works in case management and she does,discharge planning and for those who,dont know the case management,department is split into two sections so,you can either do discharge planning or,you can do whats called a utilization,review okay and so shes interested in,jumping over to the utilization review,side of case management and shes asking,is it difficult now the answer to that,question is it is not difficult in,comparison to discharge planning I,personally feel like its easier okay,and utilization review is a good career,choice for those who are looking for a,structured schedule with no surprises,like you know when you do utilization,review you know what to expect the next,day the next day youre not gonna get,any surprises like doing bedside care,where somebody you know happens to get,into cardiac arrest and now you have a,code blue or or in discharge planning,where you know theres lack of,communication and then the patient,discharge becomes delayed for some,reason so utilization review is nice,because you dont really experience any,of those issues youre basically just,going to be looking at patient charts,and reviewing all the progress notes,reviewing the patients vital signs lab,values and the medications that theyre,scheduled on and trying to determine if,there is medical necessity for the,patient to remain in the hospital,thats essentially what a utilization,review nurse does and then once the,utilization review nurse determines that,there,is medical necessity for the patient to,remain in the hospital in a hospital bed,then they communicate that information,over to the patients insurance and,usually what happens is the utilization,review nurse will fax over clinical,information to the insurance and then,also what a utilization review nurse,does is they use and so they a,utilization review nurse determines,whether a patient has medical necessity,to remain in the hospital by using a,tool called inner core and inner qua is,a set of guidelines so that will guide,you in determining whether the patient,should remain in the hospital and so,just to focus on Julie Bonners question,is utilization review difficult no I do,not think it is difficult actually a lot,of people that have gone into the,utilization review department with no,experience say that its it could be,monotonous and tedious but Ive never,heard anybody say that its difficult or,theyre leaving the department because,its hard and they dont understand,usually people just leave the department,because they just feel like its it gets,tedious because youre youre,essentially its basically a desk job,theres very little little patient,interaction youre primarily going to be,talking with like physicians every now,and then just to get orders changed but,other than that I mean youre fixed to,your desk and your computer so if thats,something that youre looking forward to,youre looking for a job that stress,levels are lower then I would recommend,becoming utilization review nurse and,just one I just want to clarify things,just because it is an easier job,this job is still a very important job,because your clinical reviews are,necessary because without them without,you communicating with the patients,insurance the hospital is not going to,get reimbursed for the medical services,that are being provided to the patient,oftentimes when the patients insurance,doesnt receive these clinical reviews,and clinical information theyll act,there they will deny the patients,hospital stay meaning they wont pay the,hospital for the services that were,provided to the patient so anyways this,is just this is just a quick response to,her question I hope this question this,answer helps you guys out like this,video and subscribe to this channel if,you found this video helpful Ill see,you guys later
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What is Utilization Review? | Nursing away from the Bedside….
hey Claires welcome to my channel Court,that is that Claire if you are a new,viewer hey there hey welcome to my,channel if you enjoyed this video please,dont forget to like us a like and,subscribe if you are oldie but a goodie,a returning viewer hey gray hey boy hey,whats good you know if I have on these,blue skirts that is a nurse related,video so today were going to be talking,about utilization review and I talked,about this before in a previous video,called why I left Nursing so you need to,go ahead hit pause if you have not,watched that video if you have not watch,that video check my description box,theyll be a link gonna watch that and,then come on back and it will continue,to that group and if you have seen it,already go ahead and keep on watching we,talked about utilization review in that,video and I just got a lot of questions,concerns and just I felt like it would,be good for me to provide my wealth of,knowledge if you can call it my my world,wealth of knowledge in regards to,utilization review because I know when I,search going into the to this specialty,it wasnt a lot of information so um,yeah if youre interested honey if you,thinking about leaving the bedside I,want to know your options youre just,interested in a specialty you heard,about it didnt really know what that,means or if you just want to be playing,on those hear me and get the nurse team,go ahead and stay tuned get hit like,subscribe okay so there are two sides to,utilization review theres the payer,side which is the insurance and theres,the provider side which is the hospital,and I can only provide you information,or my perspective from the hospital side,because Ive only worked in the hospital,setting as the utilization review,nursery nurse so what is utilization of,you,well youll and ensure view is a subset,of case management and basically what we,do is we review charts for the,appropriate appropriate utilization of,hospital services and this basically,boils down to levels of care inpatient,observation I know if youre doing your,chart checks and youre checking on your,orders like we always talked about you,will see a status order observation and,impatient these are levels of care these,levels of care are important to the hot,because it determines the amount of,money or determines yeah the amount of,funding that comes back in reimbursement,from the payer this is important from,the tech side because it determines how,much money that they have to give to the,hospital so levels of care are very,important especially if your patient,does not have a level of care or the,patient is in then not an appropriate,level care this can result in a denial,of payment or if your result in a lack,of payment or could result in a full,immerse me so this is important because,it is the money of the hospital so,utilization review its like this whole,facet that is behind the scenes its,kind of like having a watch you know,child way back in the day when people,used to buy the watches off the Canal,Street honey then things went last past,like two weeks two months if youre,doing good because the insides wasnt if,I wasnt wasnt good well the same thing,is the jewels honey lets be clear,because I know about watches and stuff,but the inside of the watch isnt good,so thats the same thing with,utilization review we are the background,of the hospital but if we are not,working efficiently and proficiently,then the hospital does not receive the,money that it needs to operate and make,sure that it is providing efficient safe,care because that goes the money goes,back into jobs and quit me and supplies,yada yada yada so um how do we determine,appropriateness appropriate levels of,care well there are two national,regarded guidelines and that is melamine,or it can be called mcg and intercom um,these are nationally renowned like,nationally known and we all kind of use,them as guidelines I say guidelines,because its not definitive sometimes,you have patients that dont meet the,subsets that are provided and these,patients are reviewed you know from a,medical necessity perspective now,depending on your facility medical,necessity can be decided by a physician,if you have a physician advisor or it,can be decided by the nurse using her,clinical judgment this is why a lot of,hospitals have,having a push to hire registered nurses,in this role because second to,physicians we have the highest level of,clinical judgment so to speak no tea no,shade okay so um I know some of you,asked about training well the only way I,know that you can get training,especially with these systems is through,on-the-job training thats how I got,training once I was on the job then I,got more in-depth training from the,actual providers Milliman and Inter qual,and also Ive got questions about,experience so that goes back to the,clinical judgment part thats why they,need nurses for this they need nurses,for utilization review because we use,our clinical judgement when the systems,the medical necessity cannot be defined,through the system the guidelines so if,you dont have much clinical experience,to go on Im not quite sure how much of,a service will you be our good service,or how much of a benefit you will be in,this role but that does not mean that,you cannot do utilization review I just,think it depends on the employer okay a,lot of times utilization review gets,confused with CBI clinical documentation,improvements and um nursing informatics,I look at my little nut shell sorry um,nursing informatics so let me just,explain the little bit that I do know,about these specialties and if you are,CDI nurse or you are nursing informatics,nurse thats actually in practice go,ahead and drop some comments give me,some information because actually I,would like to know more about those,specialties myself but from what I do,know clinical documentation improvement,so utilization review nurses we ensure,that appropriateness for levels of care,so the pace so that we can get the,hospital can get reimbursement clinical,documentation improvement they come in,and they make sure the physicians,documentation allowed aligns with the,billing and coding so that way when its,time to actually submit the information,on the back end to these payers,insurances,there are the documentation lines up in,the coding lines up so thats just,another technical side of things and,like I said thats all I kind of know,about that Im not an expert in that,area however Ive also heard about,nursing informatics and from what I,understand its using nursing to on,integrating technology and in biomedical,equipment to ensure that we are giving,safe patient care along with the,efficiency of nurses charting so they,use a lot of nursing informatics to help,build these systems like your epics and,youre Citrix is the Citrix excuse me,epic and Cerner to ensure and I know,both the system so where my head today,um epic and Cerner to ensure that they,on these EMRs are efficient for nurses,and nurse interaction so thats where,kind of nurse informatics comes into,play okay so more information about,utilization review is that generally,speaking this role is salary okay so,many of you are one of those nurses who,like to get to the game and get your,little twelve twelve hour shifts six,days a week,type thing you like your overtime this,might not be the length for you because,generally speaking they dont really,give over time you may get a bonus shift,or you may get time and a half on your,holidays but as far as I record racking,up the extra days and extra pay this,might not be your ministry sis um and,also shift hours so I work 14-hour,shifts some of my colleagues work five,eight and I even know some utilization,review nurses who do three twelves but,theyre generally in the IDI setting,interactions so if you are a nurse who,absolutely loves patient care and thats,what you want to do you dont want you,know you love your patients as we all do,but you just want to be hands-on all the,time utilization review may not be th
LOCADTR Concurrent Review Module: A Clinical Conversation
welcome to locator concurrent review,module a clinical conversation my name,is Karl Eliseo director of healthcare,reform,consultations at Center on addiction and,managed care Technical Assistance Center,this webinar will address the importance,of locator concurrent review this is a,wonderful opportunity to hear directly,from to plan medical directors and the,Oasis chief medical officer about the,critical use of locators and current,review in clinical care with me today we,have mark Manzo chief medical officer of,New York State Office of alcoholism and,substance abuse services Pat Lin court,associate commissioner of Oasis dr. Phil,Gianelli medical director at beacon,health options and doctor needed care,senior behavioral health medical,director at optimum health,hi Im going to turn it over to you to,start us off thanks and welcome,everybody were really excited to be,here to have a conversation with medical,directors who experience with concurrent,review from a plan perspective and our,brand new a way past chief medical,officer to talk about this really,crucial I think conversation for right,now we are making sure that people are,aware of our concurrent review modules,been out for about a year plans and,providers are having conversations with,this concurrence to review module its,really important to know that the,provider has a responsibility to ensure,that people are admitted to the right,level of care and that theres that,continuously review at some point to,determine whether or not that person is,in their correct level of care for it,and if theres a need for for an,alternative level of care its really,important that you understand how logic,works in the concurrent review module so,that you can explain and,you meant the reasons for your,decision-making the tool could support,that decision you are responsible for,identifying the reasons that you use the,tool in the way you did and answer the,open questions and the way that you have,its also important to understand that,reviews and because of those legislation,you wont have a prior authorization,conversation with the plan but you,should be having clinical conversations,about the plans members who are in your,care to make sure that this church,planning is happening that you have all,the information you need and that if,there is a retrospective review of that,case that you furnish the information as,needed by the plan to determine that,that care was medically necessary so Im,going to turn this over for a wonderful,conversation with the doctors who have,clinical experience as well as a plan,medical care thank you so much Pat this,is Mark man so the chief medical officer,always speaking so when you use a,concurrent review module its purpose is,insulting the continued state decisions,and good care and treatment planning,around clinical matters so I just want,to emphasize that its used when a,person is already in a level of care is,being reviewed for continued today,so as Pat alluded to even though you,will not have to do a prior,authorization within 14 days person,still does have to meet medical,necessity and its the expectation that,you document that through the concurrent,review locater done at least once during,a detox admission and clinically,determine when its done during a longer,residential stay and also that you,youre having conversations with the,plan clinical conversations with the,plan during the time to assist with,treatment planning and discharge,planning so now I want to ask dr. care,how do you think about the level of care,and substance use disorder treatment,Thank You doc commendable and I want to,stay back wonder what I discuss here,today is my opinion only,does not reflect that of optimal anybody,else so saying that you know we really,want what is best for our members and we,understand that addiction is a really,you know severe disease with a lot of,comorbidities it has been recognized now,as a chronic brain disease which,includes a lot of relapses lapses so,rollercoaster drive for the members and,their families so its very important,that we provide them with a necessary,education and treatment that they,deserve and need now when we are doing a,locator in a concurrent setting it is,very important to remember that it is,not it is not just a cross sectional,view of the member at that point in time,that we also understand what is going on,with that member that requires the,member to be at that level of care and,then you know a locator is discussed,with us it is also important for us to,know what is going on otherwise what is,going on with the comorbidities are,there any comorbid medical or,psychiatric symptoms if it is a module,management are they protracted,withdrawals which are complicated,because of other medical issues and are,those being addressed our the white of,science you know is zebra or cows cope,they monitor so all that is very,important because we want to think of,this member from a holistic point of,view taking into consideration what is,best for the member and making sure that,the treatment is more individualized as,each member comes from a different,aspect at that point in clinical setting,and a standard treatment may not be,applicable for them at that point so,that is why we you know we want to focus,what is important for that member at,that point in time without making it a,cross-sectional view so now the logic of,the locator has two fundamental,questions for concurrent review one,involves the medication assisted,treatment and the second is why does the,client need 24-hour medical supervision,monitoring within that therefore,subdomains so theres theres aspects of,the clinical picture related to,withdrawal medical conditions including,pregnancy psychiatric conditions and,then the housing in the recovery,environment the person will be going to,the doctor Gianelli Im wondering if I,could get your thoughts about the two,fundamental questions in the locator,logic,well absolutely thank you document so I,also want to add that my comments and,opinions are my own and do not,necessarily reflect those of beacon,health options or anyone else for that,matter you have the two fundamental,questions I mean medication assisted,treatment at this point is standard of,care evidence-based treatment it is,fundamentally important that our,patients members who are admitted for,treatment for withdrawal management as,well as other levels of care but,focusing on withdrawal management that,the role of medication assisted,treatment medication supported Republic,of a recovery is stressed and that the,conversation is had with the member,patient and that its documented that,has been you know it has been broached,and the reaction and the fact that you,know it really is fundamental for,stabilizing our patients in their,initial abstinence and recovery,we have great medication especially for,opioid use disorders in the form of,buprenorphine naltrexone is vivitrol,injectable and not to be neglected or,forgotten method on which really is a,gold standard for medication assisted,treatment and has been for decades so,the second question again the,documentation which will be coming up as,a recurrent theme in our reviews is,fundamental on was MIT offered and what,was the response and was it revisited,the second question why does this client,need,many for our medical supervision or,nursing level of care do they need,monitoring what are the withdrawal signs,and symptoms as dr. Kerr said do we have,cows do we have a co-op or indicated,inappropriate do we have documentation,of vital signs and especially the vital,signs and cows and see what in response,to medications for withdrawal management,on any medical extraordinarily important,pregnancy other issues with pregnancy,for our female of patients and members,any other medical co-occurring disorders,that need to be identified at stress,there are some folks I now for including,medical management in some of the OSS,facilities would youd be wonderful on,psychiatric comorbi
Day in the life of a WFH Utilization review nurse + applying for job| Nurse VLOG
good morning you guys another day of,working from home so Im just gonna be,vlogging today per usual and I am about,to log on if you guys havent seen my,first work at home day Im gonna link it,up here for you guys but yeah Im gonna,go make some coffee and Im gonna turn,this on and get it ready I always love,how these lights look like when they,turn on so lets see oh and then I was,watching a YouTube video,no Im gonna put this right here,probably change it Im probably gonna,listen to a podcast honestly so I did,try to get dressed a little bit better,today Im just wearing like this coffee,and hustle sweater and then my leggings,but uh I did my hair a little bit too,like did a little wave and then a little,bit of makeup I do want to film later,today a video which will be posted,before these work from home videos but I,just havent had time to film so thats,why I decided Ill just get ready today,plus I feel more productive more like,alive more awake like just better,alright I need a coffee no this is legit,my favorite cup ever so Im gonna use,this one,[Music],[Applause],[Music],okay for now thats what I want to dream,[Music],its good to the office and I already,have my water here because I havent,been drinking water oh my god I almost,feel my coffee so I have to drink some,water,okay you guys I have a lock on my door,so I can have some privacy since Ill be,working you know and also Im gonna,listen to a podcast just because like I,mentioned in the previous video usually,what I listen to at work is a podcast so,the podcast I listen to they kind of,bury like right now Im really been into,crime junkie but I havent heard it for,like a week no like two weeks because,you know I was working on the floor but,I think thats what Im gonna listen to,I love listening to crime junkie theyre,so entertaining but then at the end Im,always like scared no way so Im gonna,do that ooh implement lipstick killer,that is so weird,okay Im gonna do that but anyways Im,gonna start that and then,oh its 720 minutes Im gonna check in,and Ill see you guys later,all right you guys so just go from there,and make sure Im not missing anything,that looks like we have a meeting today,so to probably be through Skype or we,have to call it in Im not sure Ive,done this before,Im assuming if thats how the last call,we had was I didnt find out yesterday,because I had to find out everything,about my health insurance since Im,gonna lose my health insurance now that,Ive resigned from my job so apparently,its like the last day of the pay period,plus 31 days,so at least Im covered or my health,insurance until the end of May so that,is great it saves me a month of having,to find a new insurance so I think I,mean just stick with the one I have but,Im not sure but I also have to find out,some other things that are kind of,pending um but I need to find out about,because yeah I dont know I have so much,vacation time and comp time and all that,so Im assuming that Ill cash out but I,just want to make sure the comp time,well because I have quite a few hours in,there no I dont think we have a meeting,its not showing were doing oh I think,yeah we do have a meeting just like a,quick 30-minute meeting so thats not,bad its already 1c oh my god crazy okay,let me get to work now Im gonna open up,all my systems like the different,softwares that we use I said with their,cool colors I dont know Im not like an,IT person I dont know what theyre,called theyre different applications,thats what it is Im gonna open it up,and Im just gonna start going through,my alerts and see if anybody has sent me,anything,urgently to do if not Im gonna catch up,on all the backlog information in,regards to my patients that Ive been,working on because as you guys know Ive,been at the bedside so I havent really,been focusing on my actual job duties,which is why Im assuming that they took,me out of the labor pool so I can focus,on it so Im gonna catch up on that and,then well go from there,so I just checked my voicemail from work,through my phone and I dont have any,voice no so thats good that means I,dont have to catch up on anything and,Im just gonna start reviewing the,alerts I get sometimes when I get our,bye unless I mean like messages and then,Ill get from providers from my team,members just like anybody who has access,to this system can send me a message so,for example if,a patient doesnt want to continue with,a certain vendor then we try to look for,somebody else that theyd be willing to,see or I have to reach out to our third,party administrator who does like the,building and all that so it could just,very like sometimes there will be,patients who need MRI reports and Ill,have to fax that over to the companies,but because of everything thats going,on in the world right now a lot of the,doctors offices are closed or are,minimizing how many patients theyre,seeing by the day and of course any,elective procedures are not really being,done because of the risk you know,especially if youre immuno compromised,youre not gonna go have like a,procedure or something and just youre,gonna be worse off by doing it so just,really quickly before I move on with,this video so if you guys dont know,what it is that I do I am actually a RN,so Im a MD registered nurse and I work,at a hospital and I have a video where I,share with you guys a little bit more,into detail what it is that I do so Im,gonna link it up here for you guys but,its we dont usually work from home the,plan was to eventually work from home,but right now like I said Im only,working from home because of everything,thats going on in the world and also,because its my last two weeks but,thats why but anyway to go check out,that video if you guys are interested in,any more information so I came across a,few consults that needed verification,whether the patient was seen or not,so I sent a message through the,patients chart to my team so that they,can follow up on that and they need to,first inquire if the patient received,care and,if he did or she did then at that point,they need to obtain medical records so,they can become a part of their chart so,Im doing that it looks like theres a,lot of them and were running a little,behind on so we need to verify that,information all right you guys its a,lunchtime so Im gonna go pick up some,lunch,theres no I love Big Mac so not my Big,Mac and Im just gonna sit here and eat,while I work so I dont waste any time,[Music],Im listening to crime junkie and it,just creeping me out cuz Im home alone,then Im like and I keep seeing a little,shadow and its my dog but anyways its,one oclock right now and what Im doing,is Im reviewing medical records so what,happens is that when theres a console,thats placed we make sure that the,patient had their appointment that they,did go to their appointment and then we,retrieve the medical record and once I,review the medical records that I can,see like if theyre requesting like MRI,or any other imaging then at that point,thats when I try to figure out okay are,they gonna have the MRI done or not,under this specific authorization or do,they need another authorization and then,thats where we as a nurses get involved,and try to coordinate that to make sure,that there is an authorization for that,specific care that they need but Im,gonna review some of those medical,records because I have to catch up on,some of those but in the meantime lets,go back to crime junkie because I like,all right you think its 4 oclock so,Im done with my shift so thats it Im,out Im done lets log off but anyways,Im gonna go and make some tortillas,because Im hungry and I want some flour,tortillas so Im gonna help my mom out,I updated my resume and I did apply for,a position that I thought was,interesting honestly Im not really,looking for a job its kind of just like,whatever I see like remote nursing jobs,and if theyre like part-time or per,diem as I say a per diem per diem and,Im I always feel like I say it wrong,but if I find a position that I can work,fr
How To Interview For A Utilization Review Nurse Position
whats up guys welcome back to the,nursing channel,in this video im going to demonstrate,to you guys how to interview for a,utilization review nurse position,i know a lot of you guys have been,asking me to do this video so,here we go i made it for you guys so in,this video im going to role play im,going to act as the interviewer and im,also going to asking the questions and,im also going to act as the interviewee,answering the questions so i got about,10 questions,that theyre most likely gonna ask you,during a utilization review,nurse interview okay,so,lets get started,hi my name is sam nice to meet you,hi sam nice to meet you thank you for uh,coming to the interview,um were glad that you expressed,interest in this position weve been,looking for somebody and so we hope that,this,we hope that youre the youre the,correct candidate for this position so,lets get started we got a few questions,for you and the first question we have,for you is,what is your employment history,uh so my employment history is i started,working as a med surg nurse for uh,for a company called adventist health,and that was in a hospital,in in the state of california,as a med surg nurse i took care of five,patients at a time doing wound care,giving medications starting ivs hanging,iv bags,communicating with the doctors,communicating with other members of the,interdisciplinary team like the physical,therapist the speech therapist,and uh also i was uh i also uh,delegated,to uh,the nursing assistants and you know just,working as a team,um as as a medical surgical nurse also,besides that i also uh worked,in telemetry and in the icu in telemetry,i took a take care of four patients that,were on a cardiac monitor,and um yeah i did full patient care for,them and,also in the icu,which was a more intensive care um,i i did that at the same hospital and,i did everything from,just monitoring the different lines,monitoring the lab values and just,communicating with the physician,communicating the patients overall,condition any improvements or,if the patient was declining and just,doing full patient care,all right thank you very much for that,answer sam the next question is why do,you want this job,so,the reason why i want this job is,because im looking to transition,outside outside of patient care,ive noticed that,you know,doing patient care can take a toll on,your body and im looking for a position,where i can stay in in it long term,um a position that i can retire with and,i looked into utilization review and i,really liked the,the job duties that a nurse does because,you need you still need to utilize your,your nursing skills your nursing,critical thinking skills and not only,that but you also get to uh,contribute to the hospital or the fight,or the medical institution financially,by making sure that,the patients insurance is being billed,correctly,thank you very much for that answer sam,the other question i have for you is,have you ever had to deal with any,irate or angry patients or family,members and how did you handle it,yeah i can remember a time when when i,was working with a patient who,had a difficult time at the hosp at the,hospital,because he felt like his pain was not,being adequately controlled,he kept complaining that the doctor,wasnt giving him the correct pain,medication and that none of the nurses,were were listening to him so when i was,his nurse i listened to his concerns,and as a nurse i wanted to make sure,that i advocated for him so i told the,patient hey i understand youre in pain,and you feel like the current pain,regimen is not helping you out let me,speak with with the doctor and see what,we can do for you so i called the doctor,and told him hey i just explained the,situation to him that the patient wasnt,didnt feel like his pain was being,managed appropriately so,um,thank thankfully enough i was able to uh,to to come to terms with the doctor and,the doctor prescribed him a different,pain med regimen,and this new pain regimen that he,prescribed to the patient actually,worked a lot better so the patient just,felt like his pain was,was being treated a lot better and he,was just thankful with me that you know,he,he even gave me a good review in the,hospital so,um,that was one way that i,that thats one way i would,now thats one example of how i um,handled a,a patient that was upset,okay thank you sam and whats the next,question i have for you is how do you,handle stressful situations,so me the way i handle stressful,situations is i always,tell myself that i need to be calm,collected and composed because,if you are,just too anxious or you feel like you,have too much pressure or you feel like,when you allow your emotions to take,take control of you then your your your,thinking becomes clouded and you cant,think very clearly so,when im in a position where theres a,lot of pressure and a lot of stress i,try to keep myself calm,and compose as much as possible so that,i can think clearly through the,situation,and be able to handle it,correctly thank you very much sam,uh the next question i have for you is,can you work under pressure without,losing your cool,yeah definitely i um,ive trained myself through multiple,situations to,keep calm,under stressful situations i remember,working on the floor,there would be a lot of cold blues,and my patients would be declining,rapidly and i had to,intervene for them and i remember,that i always stayed calm and collected,and i was able to delegate to my other,colleagues so that we can all,work as a team to help this patient get,better,so yeah,thats my answer,um thank you sam the next question is,how would your best friend describe you,my best friend would describe me as a,person thats,energetic,patient,and,all is always looking to do something,he would describe me as a person that,cannot stay still that always is looking,too,like for example im always trying to,keep myself busy even if i have down,time i always try to keep my i try to,keep myself busy doing,doing some type of hobby whether thats,working on my car,going to the gym to work out reading a,book,visiting a friend or family member,thats the way,my friend would describe me,very good sam,my next question is what motivates you,what motivates me is being,is is being able to,impact someones life,in a positive way,as long as i know that whatever im,doing,is impos is making an impact in somebody,elses life,positively,that is what brings me motivation thats,what brings me excitement thats what,gets me up in the morning every day,very good sam uh next question for you,is how do you prioritize your work when,several tax tasks come up at once so,uh,the way i would like to answer that,question is i remember i was working on,as of when i was working on the med,search floor,youre always put being put into,situations where theres lots of things,to do at once,but you but you have to realize youre,only one person so you can only do one,thing at a time,so i always i would always have to,prioritize what im gonna do first and,what im going to do last,for example,when a patient,patient was complaining of pain and i,had another,patient,pressing the call out because he needed,to go to the restroom,and then i had another patient that,needed to discharge home,i i would always,look at all three patients and see which,patient,needs my attention first and and then,determine which patient,i can see last for example the patient,that was discharging i know i could see,last because theyre already medically,stable,and so they dont need my attention,right away,the patient thats complaining of pain,i will prioritize because,you know,pain is something we dont want to allow,our patients to experience for too long,and if we can control it as much as,possible i want to be that person that,can,intervene so thats thats the way i,would prioritize my tasks,very good sam the next question i have,for you is what are some important,skills for you for the utilization,review nurse,position,im sorry sam let me ask you that,questi