Blue Cross nurses...question

[jk82]

I am thinking of applying for an open CM position with AmeriHealth Caritas and heard that they fall under the Blue Cross Blue Shield umbrella... Any input on this company would be helpful.

Thank you!

[yzarcrn, BSN, RN]

I do not recommend that company. They've had a change in CEO and let go of many very talented people. The company has lost its soul. Their focus is now on money and not so much on the good of the members and community they serve. I didn't work there, but lets just say someone I am really close to has, as well as others I know. I'd look elsewhere.

[rncm2010]

I know someone that works there that I used to work with at a different insurance company. She tells me she is micromanaged and her calls are timed, etc. She is questioned if she doesn't meet productivity numbers. On the plus side she got a raise when she went there from her prior company and she was allowed to go work from home almost immediately.

[yzarcrn, BSN, RN]

Yes, that is true with all telephonic UR positions. My company does the same thing. There've been times when a nurse was stuck on a call for a really long time so the sup listened in on the call. However, this is usually to help the nurse stuck on the call. The sup will send her a message telling her what to say or do or, if the person is irate, tell the nurse to transfer to her and she'll handle. Incoming calls handled from the queue are closely monitored(includes call handle time and case completion) as well as the number of cases completed. This info is available in real time. In other words, if you're working from home and did one case at 9 and surfed the internet until you did another case at 11, you can bet your sup is going to see that and call you out on it. Of course, it all depends on how closely you're being monitored on any given day. He/she may only check production at the end of day for one, but periodically check for another if he/she knows that individual tends to slack.

[rncm2010]

Yes, that is true with all telephonic UR positions. My company does the same thing. There've been times when a nurse was stuck on a call for a really long time so the sup listened in on the call. However, this is usually to help the nurse stuck on the call. The sup will send her a message telling her what to say or do or, if the person is irate, tell the nurse to transfer to her and she'll handle. Incoming calls handled from the queue are closely monitored(includes call handle time and case completion) as well as the number of cases completed. This info is available in real time. In other words, if you're working from home and did one case at 9 and surfed the internet until you did another case at 11, you can bet your sup is going to see that and call you out on it. Of course, it all depends on how closely you're being monitored on any given day. He/she may only check production at the end of day for one, but periodically check for another if he/she knows that individual tends to slack.

It isn't true of ALL telephonic positions, even though it makes sense for it to be. For example, the company I work for currently has UR positions that work from home and they are NOT micromanaged at all. They have loose quotas but they are very understanding that some cases take longer than others. My opinion is that if you work for a larger company, especially a national one, you will see more micromanaging and metrics than if you work for a smaller company like I do. We have around 1500 employees and serve only one state.