working for insurance company?

nizhoni · Oct 30, 2007

Hello All!
Ok, I'm desperate to find a job where I can work weekends and evenings only to avoid putting my little guy in daycare. Thing is....I have no hospital experience as an RN and the only things I'd be interested in doing inpatient (like NICU) I would never be hired to do part time working evenings and weekends only.
Right now, my family is my priority, and I want to avoid daycare for multiple reasons. I'm exploring all my options, and one of them is working for an insurance company (telephonic position). It's basically pt ed over the phone.
Does anyone out there work for an insurance company? If so, how do you feel about it?
Any thoughts (especially from nurses who have or are currently working for an insurance company)?
Thanks!
Alma

I work part-time for a Medi-Cal HMO in California. We administer benefits for a Medi-Cal population that is pretty high-risk from a case management standpoint. This job has been a great experience. I have done something of everything here: disease management, outpatient high-risk case management, referrals authorization, and I am now doing perinatal inpatient case management. All of these have been telephonic positions for me, although the med-surg and pediatric CMs travel to various hospitals to speak with the patients, CMs and physicians there. Obviously different insurance companies will offer different working environments, etc., but I would definitely recommend that you check into it further.

Insurance RN · Oct 30, 2007

As my screen name implies, I work for a HMO in western NY as a Certified Case Manager. It is a fantastic job. But I must caution you, it is a job where you need to know something about everything, you must be able to prioritize and then change gears at a seconds notice. I doubt very seriously that if I had not worked for so many years at a hospital that I would be able to do this job. I know many hospitals in my area that would definitely hire someone for part time evenings and weekends, but I doubt in NICU w/o previous experience.

Good luck in whatever you choose.

nizhoni · Oct 30, 2007

I would like to mention that telephonic disease management will be a different role than that of case manager. It is not likely to be as fast-paced. Our HMO has trended away from a disease management model. Most of us "old guard" nurses still feel that it's important, but with limited staff the administration wanted to concentrate on high-risk/high-dollar patients. Makes sense, just wish we had more staff to focus on prevention.

I have not worked in a hospital since 1988. My only hospital experience since graduation from my nursing program has been in labor and delivery, postpartum and nursery. So I would not be an appropriate choice for med-surg inpatient case manager . . . but I am a licensed midwife, which is why I was assigned to perinatal!

RN1989 · Oct 30, 2007

Look at the fine print. Several insurance companies told me that they required you to work allnighters to get things done. And they made you sign a form stating that you were aware that this job did not guarantee that you would be working the hours that you wanted. When I asked around, I found out that they had a high turnover and those that were left were having to work OT, at odd times of day, etc. to cover. And if you refused to do all the extra work you were sent packing. They wanted me to give them my life. The hospital do to but they usually don't make you sign a statement to that effect. Which makes it kinda hard to fight.

Almabella · Oct 30, 2007

I would like to mention that telephonic disease management will be a different role than that of case manager. It is not likely to be as fast-paced. Our HMO has trended away from a disease management model. Most of us "old guard" nurses still feel that it's important, but with limited staff the administration wanted to concentrate on high-risk/high-dollar patients. Makes sense, just wish we had more staff to focus on prevention.

Just curious, what is this type of work like? The job description says something like "handle incoming calls in order to provide information that will empower them to make positive healthcare choices." Sounds good enough. Does the drive to save $$$ ever impact what kind of advice you can give patients, since you are working for the insurance company (and not the pt)? Not sure that'd sit too well with me...

Almabella · Oct 30, 2007

Look at the fine print. Several insurance companies told me that they required you to work allnighters to get things done. And they made you sign a form stating that you were aware that this job did not guarantee that you would be working the hours that you wanted. When I asked around, I found out that they had a high turnover and those that were left were having to work OT, at odd times of day, etc. to cover. And if you refused to do all the extra work you were sent packing. They wanted me to give them my life. The hospital do to but they usually don't make you sign a statement to that effect. Which makes it kinda hard to fight.

Hmmmm. That sounds like a raw deal! Would you mind sharing which companies you heard this about (please PM me if you're not comfortable posting it here). From the job description I doubt I'd ever be required to work an all nighter, though.

angel337, MSN, RN · Oct 31, 2007

are you a new grad?? can you work med surg or telemetry? most telemetry floors have weekend programs and i doubt you will have a hard time finding a hospital that doesn't have evenings and weekends only. the regular staff will love you for working weekends that they don't want to work. i know you are only interested in NICU, but you have to get your experience some where. good luck on what you decide.

CseMgr1, ASN, RN · Oct 31, 2007

Look at the fine print. Several insurance companies told me that they required you to work allnighters to get things done. And they made you sign a form stating that you were aware that this job did not guarantee that you would be working the hours that you wanted. When I asked around, I found out that they had a high turnover and those that were left were having to work OT, at odd times of day, etc. to cover. And if you refused to do all the extra work you were sent packing. They wanted me to give them my life. The hospital do to but they usually don't make you sign a statement to that effect. Which makes it kinda hard to fight.

I worked 4-1/2 years in Case Management and Utilization Management for an HMO. It was okay to begin with, but after they added 600,000 additional "lives" to the workload we already had, the job became next to impossible. Low morale, burnout and high turnover were rampant, as working conditions had taken on a "sweatshop" mentality: the harder we worked, the more they wanted...and whatever we did was never "good" enough.

Sound familiar??

dria · Oct 31, 2007

just curious, what is this type of work like? the job description says something like "handle incoming calls in order to provide information that will empower them to make positive healthcare choices." sounds good enough. does the drive to save $$$ ever impact what kind of advice you can give patients, since you are working for the insurance company (and not the pt)? not sure that'd sit too well with me...

absolutely not!!!! i am still an rn, and my first responsibility is to advocate for the best interests of the member, not the bottom line. the goal of case management is not to deny care...it is to guide the member to the right care, in the right place, at the right time.

i am wondering, since the posting specifies inbound calls only (most cms also make outbound calls) if this is a telephone triage position vs cm. be careful with the telephone triage...while it is an interesting area...in many cases it is available 24/7, including holidays...and it sounds like that may not be what you are looking for...

let me also put this as delicately as possible, and please know that i mean no offense...working at home is not a substitue for child care...you will need a dedicated workspace free of household noises, distraction, and interruption...it is very likely that your calls will be monitored, and no supervisor will look favorably on calls with a crying child, barking dog, or whining hubby in the background....

good luck to you...i hope you find what you are looking for...please pm me anytime you'd like...

Almabella · Oct 31, 2007

Thanks for the responses! No, I'm not a new grad, and I do have a wide variety of experience working w/ pretty much every age group in the community setting.

The job description makes no mention of case management, so I don't think that is part of the role. It does say a background in telephonic triage is helpful.

And no, this would not be a substitute for childcare. The position is weekend and evening, and I think to begin I would be working on site, with the potential to work from home at some future point.

I appreciate the advice here!

juliannae · Dec 7, 2011

for alden:

there is plenty of work for nurses in the life insurance industry but you need to have phelbotomy skills for a lot of

them. The pay is good at most. I find it more rewarding then the hospital or nursing home, as you have the oppor

tunity to travel and you seem to have exposure to many more people. You can set your own hours which is another nice aspect of it. Insurance companies really value and appreciate their nurses I find more than any other

setting. It is nice to be where you are needed and appreciated. The pay is good to travel. I look forward to out of

town trips, you get a change of scenery at the same time as working.

You are also called into many different work environments, you never get bored as you are never in the same

place. So far I have been to all kinds of stores, airports, many different places. I went through great disappointment in my location trying to find work, and glad I did not let other people stop me from continuing

to find a good place.

I am pretty much making the same income I was working in a facility. One company had even recognized me

and gave me and award. Most companies require that you keep your license up to date and skill level. Hope

this helps some

julianna