The Nurse's Complete Guide to Utilization Management (Paperback)
Language: English
Published by Independently Published, 2026
- Softcover
- New
Seller: Grand Eagle Retail, Bensenville, IL, U.S.A.Grand Eagle Retail
AbeBooks seller since October 12, 2005
Condition: New
£ 23.84
Quantity: 1 available
Add to basketItem description from seller
Paperback. Leave the bedside. Keep the nursing.There is a nursing career where your clinical judgment matters more than your stamina, where the schedule is human, and where the commute is a hallway. Utilization management nurses review authorization requests against evidence-based criteria and help patients get the right care, in the right setting, on time. And both RNs and LVNs can do it.Written by a working UM nurse with more than ten years in the field who helped build a health plan from the ground up, this book hands you the entire map in plain English, starting from zero. It was born in a hospital bed: during a period of illness, the author's own nurses kept asking the same questions. What kind of nursing do you do? How do you do it? How do I get into it? This book is the complete answer, written for every nurse who wants to learn more and leave bedside care.Inside, you will learn how to: Read CPT, HCPCS, and ICD-10 codes the way reviewers doProcess an authorization from fax to decision and hit every turnaround time (TAT)Handle contracted vs. non-contracted providers, including when to redirect members back into networkFind real criteria for free: CMS NCDs and LCDs, plus the public medical policy libraries of major payersUnderstand the DOFR, eligibility, benefits, and levels of careApprove what meets criteria, pend what is missing, and refer denials to the medical director the right wayNavigate tertiary facilities, Centers of Excellence, and transplant casesProtect yourself with HIPAA-smart remote work habitsInterview with confidence, whether you are an RN or an LVNThen practice with 16 complete sample case reviews. Each case gives you the line of business, the codes, realistic clinicals, the exact source where the guideline lives, and a finished review note in the format working reviewers actually write. Sleep studies, CPAP, spinal injections, power wheelchairs, MRIs, joint replacements, home health, SNF stays, hyperbaric oxygen, bariatric surgery, cardiac devices, transplants, and more.You will also get a full mock interview to rehearse out loud, quick-reference code appendices, a sample TAT grid and prior authorization grid, and a glossary that lets you talk like you have been in the field for years.If you are burned out, injured, raising kids, or simply done with twelve-hour shifts on concrete floors, this is your proof that there is another room in the house of nursing. Your license is the key. This book is the door.Camara Starks, LVN, is the founder of ClearlyAuthReady, a companion practice platform where readers can run mock authorization reviews built on the exact skills in this book. This item is printed on demand. Shipping may be from multiple locations in the US or from the UK, depending on stock availability.…
Seller Inventory # 9798186980971
- Title
- The Nurse's Complete Guide to Utilization Management (Paperback)
- Author
- Lvn Camara Starks
- Publisher
- Independently Published
- Publication year
- 2026
- Condition
- new
- Binding
- Paperback
- Language
- English
- ISBN 13
- 9798186980971
Leave the bedside. Keep the nursing.
There is a nursing career where your clinical judgment matters more than your stamina, where the schedule is human, and where the commute is a hallway. Utilization management nurses review authorization requests against evidence-based criteria and help patients get the right care, in the right setting, on time. And both RNs and LVNs can do it.
Written by a working UM nurse with more than ten years in the field who helped build a health plan from the ground up, this book hands you the entire map in plain English, starting from zero. It was born in a hospital bed: during a period of illness, the author's own nurses kept asking the same questions. What kind of nursing do you do? How do you do it? How do I get into it? This book is the complete answer, written for every nurse who wants to learn more and leave bedside care.
Inside, you will learn how to:
- Read CPT, HCPCS, and ICD-10 codes the way reviewers do
- Process an authorization from fax to decision and hit every turnaround time (TAT)
- Handle contracted vs. non-contracted providers, including when to redirect members back into network
- Find real criteria for free: CMS NCDs and LCDs, plus the public medical policy libraries of major payers
- Understand the DOFR, eligibility, benefits, and levels of care
- Approve what meets criteria, pend what is missing, and refer denials to the medical director the right way
- Navigate tertiary facilities, Centers of Excellence, and transplant cases
- Protect yourself with HIPAA-smart remote work habits
- Interview with confidence, whether you are an RN or an LVN
Then practice with 16 complete sample case reviews. Each case gives you the line of business, the codes, realistic clinicals, the exact source where the guideline lives, and a finished review note in the format working reviewers actually write. Sleep studies, CPAP, spinal injections, power wheelchairs, MRIs, joint replacements, home health, SNF stays, hyperbaric oxygen, bariatric surgery, cardiac devices, transplants, and more.
You will also get a full mock interview to rehearse out loud, quick-reference code appendices, a sample TAT grid and prior authorization grid, and a glossary that lets you talk like you have been in the field for years.
If you are burned out, injured, raising kids, or simply done with twelve-hour shifts on concrete floors, this is your proof that there is another room in the house of nursing. Your license is the key. This book is the door.
Camara Starks, LVN, is the founder of ClearlyAuthReady, a companion practice platform where readers can run mock authorization reviews built on the exact skills in this book.
"Synopsis" may belong to another edition of this title.
Grand Eagle Retail
Bensenville, IL, U.S.A.
AbeBooks seller since October 12, 2005
Shipping rates within U.S.A.
| Item | 6 to 14 business days | 6 to 16 business days |
|---|---|---|
| First item | £ 0.00 | £ 0.00 |
Payment methods
Seller's business information
APOLLO ONLINE CORP.
605 Geddes Street
Wilmington, DE U.S.A. 19805
Terms of sale
We guarantee the condition of every book as it¿s described on the Abebooks web sites. If you¿ve changed
your mind about a book that you¿ve ordered, please use the Ask bookseller a question link to contact us
and we¿ll respond within 2 business days.
Books ship from California and Michigan.
Right of withdrawal
If you are a consumer you can withdraw from the contract in accordance with the following. Consumer means any natural person who is acting for purposes which are outside his trade, business, craft or profession.
Information regarding the right of withdrawal
Statutory right to withdraw
You have the right to withdraw from this contract within 14 days without giving any reason.
The withdrawal period will expire after 14 days from the day on which you acquire, or a third party other than the carrier and indicated by you acquires, physical possession of the last good or the last lot or piece.
To exercise the right of withdrawal, electronically fill in and submit a clear statement on our website, under "My Purchases" in "My Account". We will communicate to you an acknowledgement of receipt of such a withdrawal on a durable medium (e.g. by e-mail) without delay.
To meet the withdrawal deadline, it is sufficient for you to send your communication concerning your exercise of the right of withdrawal before the withdrawal period has expired.
Effects of withdrawal
If you withdraw from this contract, we will reimburse to you all payments received from you, including the costs of delivery (except for the supplementary costs arising if you chose a type of delivery other than the least expensive type of standard delivery offered by us).
We may make a deduction from the reimbursement for loss in value of any goods supplied, if the loss is the result of unnecessary handling by you.
We will make the reimbursement without undue delay, and not later than 14 days after the day on which we are informed about your decision to withdraw from this contract.
We will make the reimbursement using the same means of payment as you used for the initial transaction, unless you have expressly agreed otherwise; in any event, you will not incur any fees as a result of such reimbursement.
We may withhold reimbursement until we have received the goods back, or you have supplied evidence of having sent back the goods, whichever is the earliest.
You shall send back the goods or hand them over to Grand Eagle Retail, Bensenville, Illinois, U.S.A., without undue delay and in any event not later than 14 days from the day on which you communicate your withdrawal from this contract to us. The deadline is met if you send back the goods before the period of 14 days has expired. You will have to bear the direct cost of returning the goods. You are only liable for any diminished value of the goods resulting from the handling other than what is necessary to establish the nature, characteristics and functioning of the goods.
Exceptions to the right of withdrawal
The right of withdrawal does not apply to:
- The delivery of newspapers, journals or magazines with the exception of subscription contracts; and
- The supply of digital content which is not supplied on a tangible medium (e.g. on a CD or DVD) if you accepted when you placed your order that we could start to deliver it, and that you could not withdraw once delivery had started.
Shipping terms
Orders usually ship within 2 business days. All books within the US ship free of charge. Delivery is 4-14 business days anywhere in the United States.
Books ship from California and Michigan.
If your book order is heavy or oversized, we may contact you to let you know extra shipping is required.