The UR terms you’ll hear on day one, explained clearly.

Utilization review comes with its own language. This guide explains the terms you’ll see in job postings, interviews and your first weeks on the job, in plain words.

What’s inside:

Core concepts: medical necessity, level of care, severity of illness (SOI) and intensity of service

Length of stay terms: LOS, GMLOS, GLOS, avoidable days and readmissions

Review types, with a simple timeline diagram

Outcomes and processes: escalation, peer-to-peer, denials and appeals, with a flow diagram

Related roles: physician advisor, case management, CDI and the UR committee

Insurance terms: in-network, out-of-network and single case agreements

Medicare terms: Two-Midnight Rule, Condition Code 44, MOON, IMM and more

A quick-reference glossary of 23 common abbreviations

Perfect for: Nurses preparing for UR interviews, new UR nurses, and anyone moving into case management or utilization management.

Created by Casandera Brown, LPN | Nurse Review: Utilization Review for Nurses

Instant PDF download, 10 pages. Licensed for personal use only.