A Typical Day In the Life of a Therapist Turned Utilization Reviewer

A Typical Day In the Life of a Therapist Turned Utilization Reviewer

What does a UR professional actually do?

So you’ve researched UR and maybe even taken our course, but you still aren’t sure what a Utilization Reviewer actually does. Don’t worry — I was totally in the same boat when I first started my own transition to a non-clinical role. But now that I’ve been in my UR role for almost 9 months, I can help demystify the actual day-to-day tasks.

I’ll be honest — every day is more or less the same. If you get bored doing the same things day in and day out, a UR role is probably not going to bring you long term happiness. However, some people find security and comfort in the predictability. At mine, the workflow moves fast and your productivity is monitored. Even though you’re working from home, it’s not leisurely.

Keep in mind that the demands of a UR position will differ from company-to-company. It’s totally worthwhile and appropriate to ask a current employee or the person who interviews you what a normal day looks like. If you want to connect with working UR professionals and current students, join our Facebook group at [link].

My typical schedule looks like this, day in and day out:

8:00 am - Wake up slowly, put on a fresh pair of sweats and a comfy t-shirt, and make my way downstairs.

8:30 am - Take my dog out and enjoy my first cup of coffee on the porch, then make a bowl of oatmeal to take to my desk.

8:58 am - I make the 8 second commute to my office, where I sit down at my desk and log into my computer.

9:00 am - I pull up the web clock just in time and clock in.

9:03 am - I finish checking emails and log into my phone so I can start taking calls. 

9:10-9:14 am - I get my first call which just takes 5 minutes - a provider just wants to remove a CPT code from a pre-authorization request. 

9:15-10:30 am - I get 5 more calls and review 6 more web cases. About half are approvals while the other half do not meet my company’s clinical criteria for medical necessity. One of my calls is from a physical therapist for a peer-to-peer discussion. Ultimately the request meets criteria for a reconsideration, so I call one of our physicians, communicate the situation, and transfer the therapist to them to finish the reconsideration process.

10:30 am - It’s time for my first 15 minute break of the day. I set a timer and log out of my phone so I don’t get any calls. Then I take my dog outside, hit the bathroom, wash my breakfast dishes, and start a load of laundry all before my break ends.

12:01 am - I get a knock at the door. My dog goes crazy and starts barking. I briefly log out of my phone so that I don’t get a call while I’m answering the door (it’s the mailman). I try not to prolong this interruption because logging out of my phone while on the clock affects my productivity.

11:36 am - I place outgoing calls for three cases that did not meet clinical criteria (required only for certain health plans). This slows down my workflow so that by midday, I’ve only reviewed 15 cases in total.

12:30 pm - I punch out for lunch. I heat up leftovers from last night’s dinner and scroll through Instagram. I call my doctor to reschedule an appointment, take out the trash, and put my laundry in the dryer. Finally, I do a brief stretch break on my yoga mat to soothe my chronic neck pain from all the computer work.

1:00 pm - I’m back at my desk (standing this time) and continue to review cases and take calls from providers.

1:45 pm - I have a meeting with my manager over a web platform. She reviews my quarterly performance metrics (which include how many cases I review daily, how long you are logged into your phone during the day, and how long it takes to answer a phone call) and tells me I’m on track to receive a bonus for exceeding expectations. Hooray!

2:45 pm - Time for my second 15 minute break. I go outside to check the mail and make a personal call.

4:01 pm - I receive a phone call from an angry provider who unkindly takes his frustrations with the pre-authorization process — and the healthcare system in general — out on me. I do my best to provide him with options and remind myself not to take anybody’s anger personally. Still, I feel rattled after this 35-minute call and take a few moments to close my eyes and breathe to destress.

4:55 pm - My full day of reviewing cases and taking calls is coming to a close. I send my supervisors a list of all the cases I that reviewed and received calls for today (31 in total). 

5:00 pm -  After closing out all applications on my desktop, I use the web clock to punch out before logging out of my phone and computer. 

5:01 pm - Just a few seconds later, I’m in my kitchen and making dinner! I don’t need to think about work until I sit down again at my desk tomorrow at 9:00 AM.

At the end of the day, I find myself with SO much more physical and emotional energy than I did in the clinical world. I am actually itching to get outside and do physical activity, something I never did after spending hours at the bedside. And, although managing frustrated and angry callers is definitely taxing, it’s much easier to detach emotionally (in a healthy way) from the demands of the role. But, you’ve got to be willing to settle into routine and repetition as well as work centered around screens and phones, rather than interpersonal interactions. 

If you have questions about the day-to-day workflow of a particular UR company, you can always reach out to us by email or on our Facebook group!