What is a nurse?
The nurse for review is a registered nurse who checks individual medical cases to confirm that they receive the most suitable care. These nursing experts can work for insurance companies and determine whether care should be approved in specific situations and can also work in hospitals. The aim of the members of this profession is to balance the need for a patient with the need to strengthen policy, maintain reasonable costs and ensure that patients are provided with medical treatment suitable for their situations. For example, a nurse may feel that for compassionate reasons the patient should have access to a certain treatment, but that the patient is not eligible for treatment based on the specifics of the patient's case and the hospital policy or the plan. Members of this profession must have compassion, but it must also be able to examine the situation, regardless of their decisions, which are fair, even if they can be unpleasant.
in the hospital, the nurse for review of use examines the patient cases if the hospital believes that the patient does not have to be given appropriate treatment. For example, a physician may recommend hospitalization, but the reviewer could feel that the patient does not have to be hospitalized, and it would be better to release the patient to release the bed, save money in the hospital, and save money for the patient. Nurses for recovery of use also check situations such as medical imaging studies, use of certain drugs and treatment and recommended medical procedures. Hospital nurses may also worry about whether patience meets Standards for the payment of insurance companies.
In the insurance company, the nurse controls the use of the use of claims to determine whether they should be paid. The nurse weighs the patient's situation against politics he has a patient, insurance standards and costs that can be involved in treatment. For example, requests for drugs that forThey owe life, are likely to be denied if the patient is in hospice care because hospice care is intended for the treatment of the end of life. Likewise, if the nurse of the review of the use feels that the medicine, procedure or treatment is not medically indicated, may be rejected.
You want to work in this area, it is usually necessary to organize a current nursing license and have experience in the field. Many nurses of review treats use for 20 years and are familiar with nursing administration, hospital procedures and the process of payment of insurance. Open works are listed in man nursing trade magazines in addition to public forums. Nurses who are interested in specialized work, such as review of prisoners or military members, may have to go through background checks before starting work and meet other requirements.