I did my case management job in a small hospital about 201 beds. I also used to work at United Healthcare for about 2 years before going into hospital case management. But, my typical hospital case management day began at 8 am. I usually covered the med-surg wing. I would review ALL the charts for inpatient criteria (there is a book Milliman that the hospital provided for reference). We then would send that information to the insurance company (if they had one). Depending on the census, that would take about 2.5 hours. We would have a meeting at 11 am to discuss why the patient was in the hospital to the ceo, cfo, nursing management, etc. After lunch was dc planning. Patients that had total knees would knee lovenox, walkers, bedside commode etc to go home with, or if they needed inpatient skilled care we would arrange that. Seems easy typing it, however we had a large indigent & medicaid population, and finding resources for these people was draining. There would be indigent people who would come in that had a stroke with no insurance needing inpatient rehab and you would have no place to send them, because of no insurance. I could tell you countless stories, but i won't bore you with that. Advice: Try doing your dc planning early in the week if you know they need home health services b/c by the weekend, the agencies are full and cannot take admissions. Also, detach yourself and try not to carry the day home with you like I did, I got burned out.
As far as United Healthcare, I worked in a cubicle, on a phone, for 8 hours, with people yelling at me as to why this and that service isn't covered. I got some of the WORST cases. If you want the hairy details, just send me an email.
I can understand that you want to shift gears. Nursing is very tiring, and emotionally exhausting at times, but there are silver lining moments. I have gotten many thank yous, flowers, etc, and I save those things to remind me that I am a good nurse. I genuinely care about people and their well-being, and I give 100% everyday. Good luck to you and if you have any questions feel free to ask!