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Utilization Review position

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Anyone on this forum familiar with positions doing utilization review for an individual company for various insurers?  Position is available that currently has a PA and a nurse.  Pay is very competitive and would provide flexible hours and no commute.  I would not be thrilled to give up clinical practice but am considering this as my commute and workload is becoming physically exhausting and my frustration level is increasing in clinical practice.  Ideally I would still keep myself once a week in clinical practice but not sure that I would have the option at this point.  Part of my consideration is also the flexibility to drop off and pick up my kids, struggling with good childcare options is a recurring theme and it is tempting to not have this to deal with at some point.

Thank you for any input, pros and cons...

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The company is owned by a local MD that contracts with various insurers to do their authorizations and chart reviews.    It sounds like I would have cases daily that I would need to review for documentation and determine medical necessity.  I would work at home and it would be flexible.  He has one PA, one NP and a nurse that he has employed currently.  It would be an hourly position without benefits.  I am good with that as I don't need benefits and I am planning on asking for a very high hourly rate.  The downside is I would be out of clinical medicine, although I do have to keep my license active.  I only plan to work another 10 years, but if I decide I want to go back to practicing I wonder how difficult that will be.  He has had his first employee, an NP since 2008 so I would think it must be a pretty good situation for her to stay that long. 

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Guest Paula

Go for it!  


If you can keep your PA license active and work at home, enjoy more flexibility, and recover from burnout, it might be worth it.  The sticking point is if the insurance companies pressure you to deny legitimate orders for medical necessity.   I've always wondered how that works.  Do the UR people get paid for production and saving the insurance companies money?  Less pay if you approve a prior authorization?  


As you can tell, I'm a bit jaded with insurance companies.  Might be interesting to live on the other side of the business of medicine for a while.


You could also pick up a shift here and there at an urgent care if you want to keep up your skills and knowledge....which also might help you with your perspective of being a UR officer. 


PAs can and should expand our expertise into business side of medicine. At a certain point in my career I will be looking to decrease clinical practice and move into an administrative type position of some sort yet to be determined. 

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Thank you for the responses.  I did specifically ask if there was any pressure to deny claims and he assured me there was not.  My pay is a set hourly amount, not based on claims or outcomes of what is decided.  I would feel like pay based on denying something would be completely unethical and I would never be a part of that. 

I am meeting with the Physician on Friday to get a better idea of the process and meet in person. He gave me a broad idea of the hourly pay but not sure how much he is willing to go up from there.  Will need to see if it will match close to what I currently make with benefits. 

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Wanted to update for those interested.  Had a meeting today with the MD that runs the company.  He receives contracts from various insurers and takes care of approvals and denials that need an MD to review.  I was a bit disappointed, but keeping an open mind for possible part time work.  Current position he needs someone 40 hours per week, the work is time sensitive, usually 70-80 cases to approve per day, so about 10/hour.  He showed me the process and this would be very doable and once trained I could probably do closer to 15/hour.  I could work from home and would have flexible hours somewhat.  He seems like a great person and very laid back and that he would be good to work for.

The downside is his employees are 1099, which would add another 10% of taxes taken out right off the top.  No benefits at all, no paid time off, so I am essentially a contractor.  Pay rate was "flexible" but he mentioned around 60/hour.  I am making more than that per hour with benefits and time off so that would be a hard pill to swallow.  Also as a 1099 employee I feel like I would need to make at least 70/hour to make it worth my time.  Once taxes are taken out this would probably come out to only 30-40 per hour.  I also had the hope that I could save on childcare, but they have activities after school and I do not see myself being able to run them around and do this all week, so I would still need to pay someone for that. 

I may decide to do this on a prn or very part time basis which he mentioned he would like a full time person and a part time person in the next six months. 

Does anyone have any idea how much to ask for as a 1099?  I am thinking close to 65-70/hour, I feel like by doing this it really benefits him, but is really a bad deal for me.  The problem is he doesn't seem to have a problem finding people.  He said I was one of his top two picks but he had many applicants.  I suppose it comes down to supply and demand. 

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Reverse your method of determining hourly rate.  Start with your $70/hr hypothesis.  Your employment taxes are now 15.3% versus employee only 7.65% (you can itemize these when you file your Fed income tax so you get an ~15% break on the second 7.65% payment that you're having to make).  Factor in 15% for an SEP-IRA (optional but needed since this would be your FT job it sounds like.  Based on this alone you're at $48.79/hr. and this doesn't include health insurance, or any other type of insurance for that matter (disability, life).  No professional fees are covered for you.  How do you anticipate maintaining your license since this isn't patient care based (see above)?  Also, are you comfortable with figuring your estimated taxes which are due at a minimum quarterly (I paid mine monthly when I was 1099 in the ED)?  You can pay it via EFT at EFTPS.

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I would not even consider this with a 1099 position for less then $80/hour - and likely $100 as initial


you need to have a work place, high speed internet, add in all the taxes, and such (do you need medical malpractice?)


I would just say no thank you as "I make more per hour WITH benefits right now....."



health insurance = 12k/year

PAid time off ($10k/year)

Misc things like CME and such - $2500

Medical Mal - $5k is the least you will likely get out in my state

15% for paying both sides of the taxes


you are looking at about close to $30k per year for jut bennies.....



This doc is using PA/NP as he makes more $$$

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  • 6 years later...

Hi ,

i just saw this old post from 2015. This is exactly what I am now looking for. I have been a PA for 35 years and I am more than happy to give up the clinical aspect. My goal is to work remotely, have benefits, and specialize as an Orthopedic Clinical Reviewer. Any suggestions on where to start and how to find this type of position is welcome.


Cindy Hayes, PA-C

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