I work in such an environment. I worked in the hospital for about 18 years and, frankly, after my last hospital job (I was there for 13 yrs) and what they did to me (long story) I wouldn't go back. Also, since I'm in my mid 40's I think my body deserves less abuse. There are reasons Dixielee people like this environment, and it's usually age.
I work at an independent nurse case management company which deals with numerous types of health plans. I am constantly using my nursing knowledge and learning more things all the time. The company I work for is nationwide. And, it's not the type of case management most people think of...workers comp. or the insurance company case manager who doesn't have to have a medical degree and does nothing but deny claims. I deal with doctors, hospital, home health care workers, patients, and other health providers on a daily basis.
I had one doctor tell me, as I was getting update on my patient, to get a real job. I ripped him a new one explaining I was a registered nurse, I worked in the hospital setting for 17 years, and what I was doing WAS a real job. I informed him I was a professional and as such deserved to be treated as one. Then, I informed him if he did not provide the information I was requesting, my recommendation to the health plan would be to withhold all of his claims for payment until I did get the information so I could be sure his treatment plan was medically appropriate and a standard of care for this patient's condition. I guess he wanted his money because he immediately changed is attitude, apologized, and proceeded to answer all my questions.
As for nursing experience, the company I'm working for requires five years of previous nursing in either case management, hospital, home health care, physician's office, etc. There has to be previous patient contact.