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- Sep 16, '11 by beachyfeQuote from grnteabcbs is no place for beginners. they have zero interest in training newbies as case managers, disease managers, or utilization review people for their complex suite of insurance plans when there are plenty of people with applicable experience (including case management and good familiarity with insurance products) to be had.
i don't think this is necessarily true. i had no experience in cm, dm, or um when i answered an ad for a case manager. i did have 16 yrs of clinical nursing experience, but nothing in insurance or business. i was trained on-site for 6 wks, then began working at home. i've done cm, dm, and um from home for 5 yrs now and last year got my ccm certification. so, there are some companies that are willing to train "newbies."
i would suggest using a cover letter, though, no matter what type of job you apply for. this is expected of a professional. even if you apply online, there is usually a way to upload a resume and cover letter. i do not include references on my resume, but write "references upon request." on an online application, though, i do list my references if they ask. best luck finding the position you want.
- Sep 16, '11 by kcmylornbeachyfe- I have accepted a position as a home based CM for an insurance co. How do you like working at home? Can you give me any info on the pros/cons of working from home. I do not have any young children at home so distraction is not an issue. I am still undecided about leaving my current position, which I like and I like my co-workers. I am also feeling that if I turn this position down, there will not be any more chance of getting another like this and that for an older experienced RN- this is where all my nursing peers are and this is the only place for us where we are accepted and respected for our experience.. All I have seen of the insurance nurse CM is the video on the company's web site, which is only going to give the positives about the position. This would be my first venture into work from home, CM, UM and DM. I want to get out of clinical nursing, no more hospital bedside for me(after 30+years) but I am so afraid to take the leap. My current position is temporary. The insurance co is permanent- no probation period but 3 months orientation. The clinic position is approx some(20%) face to face clinical, mostly telephonic- med refils, referrals and sx based(sending pt's to ED, urgentcare, or doctor's appt's) in a clinic but not CM/UM/DM. The patient population at the clinic is "extremely" demanding and get their way even if it's against provider better judgement.
I have accepted the position in the insurance co as a CM, will be from home, no home visits but am still on the fence about it. I have not quit my clinic position yet. I talked to another older nurse, who has never worked telephone CM but told me- it's quota's each month???? This has kind of scared me off. I was told at the interview I would have a case load of 100 patients/month of complex medical patients, some will need every 2 week reviews.
Any thoughts on what I'm in for?? Thanks
- Sep 19, '11 by rkm1005Hello,
I too tried and tried to get into BCBS for pre certification and discharge planning. Are you in Michigan? If so, try one of the agency's they will get you in on the 24/7 nurse line or the quit smoking program and if your lucky they will hire you permenately, once that happens you can apply for other positions internally. Agency's to try A-Line staffing solutions and Aerotek Scientific. I have seen postings for other agency's in other states so if you are not in Michigan try agency's in your state. Beware, pay is awful, I am making $6 less per hour than my last job and as a contracter there is no shift diff or weekend diff, you are expected to work holidays for no extra compensation, weekends are not every other-- some people work three in a row others work only one, its 10 hour shifts which sound great, but you never get three days off in a row. From Sept. 9th -15th I worked 60 hours with 1 day off, this is because pay period ended on Sat. the 10th. Its rough, but if you want to get your foot in the door without CM experience this is the only way I know of. Scheduling is done very poorly, requests were to be in 2 weeks ago NO EXCEPTIONS! and the schedule is yet to be seen, with only 10 days left on the current schedule; not that it matters because when it does come out it could very possibly change! I get the impression that management could care less if you have a life, or children, but they all know what their schedules are. I know all of this sounds bad, but I am not used to being treated this way, coming from a hospital setting where you are compensated for your off shift, weekend and holiday time and where managers have a brain in there head and don't schedule the afternoon nurses to work every single friday on the schedule. On the up side, if you manage to get hired as a BCBS employee they do pay weekend diff and holiday pay and if you can get off the 24/7 line it will be mon-fri with no holidays and they have a lot of holidays, like "black friday". The job itself is not bad, you just have to decide if you can put up with the above to get your foot in the door, no guarantees. For me, I'm looking for another job, I don't have time to wait around while they decide on hiring and the schedule is hell on my kids. Hope this helps, good luck!!
- Sep 22, '11 by beachyfeQuote from kcmylorni did 2 months of training and it took between 1-2 yrs before i really felt like an "expert" at the job. it was a big learning curve because this is all about business and insurance. a totally different ballgame from nursing. but i learned it and also got my certification in case management (ccm) last year. i've learned a whole new field and widened my opportunities. good luck - hope you like it.how do you like working at home? i love working from home, but you have to be very self motivated. no supervisor looking over your shoulder or others to see what you're doing. but if you're a self-starter, then it's a dream come true. i can wake up at 8:15am and log in to the computer at my starting time of 8:30am. eventually i get dressed, cleaned up, and have breakfast. can you give me any info on the pros/cons of working from home. for me, the best part of being at home is not having to drive to and from work (especially in bad weather). even if i might have to work longer than my shift (which happens often), i think about how i would have spent an extra 1.5 hrs driving everyday, so it doesn't seem to be a big deal to work a little over. some people don't like being alone all day - personally i don't mind (i'm talking on the phone to patients all day long) and i actually enjoy not being in a gossipy group of women. i can turn the radio to whatever music i like and throw a load of laundry in when needed. this is the only place for us where we are accepted and respected for our experience. this is somewhat true - no one is judging you by how you look. i have accepted the position in the insurance co as a cm, will be from home, no home visits but am still on the fence about it. i have not quit my clinic position yet. i talked to another older nurse, who has never worked telephone cm but told me- it's quota's each month???? this has kind of scared me off. i was told at the interview i would have a case load of 100 patients/month of complex medical patients, some will need every 2 week reviews. it's true that your productivity is based on the amount of time you spend working a case. it's called "billable hours", just like an attorney. if you think about it, how else can your company make sure you're actually doing a full day's work rather than sitting around watching tv or messing around on facebook?? so, when you contact your patient, talk to them, then document it all on the computer chart, you bill for the time it took you - but only for as much time as the company allows. basically, you have to work pretty fast and are expected to do alot. we have to have 80% of our workday as billable hours-->so if you work 8 hrs a day, then you must get at least 6.4 billable hours per day. keeping this up is part of your evaluation. my caseload is also 100 patients. it's alot and will keep you very busy; i probably call 15-20 patients a day, do their documentation, and do auths/certifications for hospital stays. btw, everything you do is recorded and can be seen by management. they record (and listen to) all your phone calls and keep a close eye on your charts, daily patient call list, billable hours, amount of activities you complete each day, etc. again, this is so they can be sure all their remote employees are really working. i used to get frustrated with not being able to spend as much time as i'd like talking with a patient, but you just can't or you'll get too far behind. not much different than any other type of nursing job, though, is it? despite all this, i think the pros outweigh the cons. oh, be sure you do some daily exercise or you'll end up with a "chair butt" from sitting still 8 hrs a day.
any thoughts on what i'm in for?? thanks
- Sep 25, '11 by FaceinthecrowdQuote from pa715Good advice. I was hired as a Medicare CM after doing home health for years. It will be well worth the investment.I would suggest doing home health for a few years before transitioning into this type of position. I just got a job with a similar company with 2+ years of HH. You'll learn case management as well as the insurance woes. Good Luck!
- Sep 25, '11 by kcmylornThank You Beachyfe for your post- It was very helpful and gave me a more realistic picture of what I'll be in for. I hope I like it also.
- Sep 29, '11 by juschillinHey-lo,
Cover letters are a must! you shouldn't have to send in references until you get to the point where they have interviewed you and said they're gonna check your references. imo.
- Sep 2, '12 by AHad40Hi, I'm interested in persuing a position at United Healthcare, but as you said in your post United doesn't hire very often.
I've noticed there's not many positions for LVN's at United Healthcare. Do they hire LVNs for Case Mgmt or Care Coordinator or Clinical Claims Review? Any advice on how to get on with the company, would be helpful. My email is listed below:
- Sep 5, '12 by bluesy51I worked for them .. and I have to tell you . They are bad news. You feel like you are in a slave ship.
they watch your every move. there is no autonomy there. they do not treat you like a professional.
And furthermore they are downsizing .. sending jobs to India and the Phillipines. They also use a lot of contract employees so they can fire them without cause when they send your job overseas.
- Sep 15, '12 by beekerQuote from mtngrlWhat was your background / experience before getting hired? Any tips?I work for United Healthcare as care coordinator in TN. I'm surprised someone said BlueCross doesn't give much orientation. I got 5 weeks at United, and they continually do ongoing training.What was your background before getting hired? It seems to me they do not hire very often. We NEED more people! Or we will be working even more than we already do....which is a LOT.I think they are a good company to work for.