Case management/Insurance work?

[SmilingBluEyes]

Good afternoon, all. I don't know if this is the right forum, if not feel free to move it, mods.

I was wondering if anyone here who works for insurance/tele triage/case management (or any other work from home job), how you managed to get in?

What requirements/experience are they looking for? How might I break into this field?

I don't personally know anyone who does this, or I would ask them.

Please let me know how you got in, and how you feel about this work?

I am, like so many, tired of abuse/foul language/physical threats, and being asked to be "compassionate" and "understanding". I would like not to have to go to work, knowing this is coming. I have done all kinds of specialties in nursing, OB/GYN surgical, LTC, Doctor office nursing, ambulatory type care in an outpatient clinic. I am familiar with ICD-10 coding and the like.

Anyhow, if anyone has wisdom or advice, I am all ears. Thank you in advance.

[NCRN2010, BSN, RN]

I work at one of the top insurance companies as a Nurse Case Manager. I started off working on the 24 hour nurse triage line. Mostly the experience they are looking for is med/surg, ER, triage. I would recommend finding a position you're interested in and tweak your resume to match the requirements as much as possible without being dishonest. Have your skills align with the requirements. Most larger companies are scanning resumes looking for keywords and an actual person does not see it unless it passes the keyword test.

Before I got my current position I applied for every position that I was remotely qualified for. It took me a couple of years to get any call. Fortunately I got the first position I interviewed for. It is extremely competitive, even once you have your foot in the door.

I understand your frustration with the mental and physical abuse you are subjected to at the bedside. That old saying "The grass is always greener" is applicable here. Sitting at home in your pajamas talking to your patients all day may sound like a dream job to someone that has never done it, but it is hard and challenging in ways you have never imagined. Think about every action and every word you do and say throughout the day. Now imagine all of that being recorded and monitored. Also, every minute of your work day is monitored and tracked. The pay at my company is excellent. There is a high turnover in some teams because management can be brutal at times. I miss doing bedside nursing and seeing my patients face to face. You have to learn to depend more on listening to what the patient says instead of what you can visualize.

If the pay wasn't so good I would have left years ago. I don't mean to be discouraging but wanting to just be as honest as possible here. Please let me know if I can provide any additional information.

[Kathie]

Hi Smilingeyes,

I "got in" 25 years ago by taking over a job that a friend of mine was leaving. Very different now!

I agree with NCRN on many points, especially :

Quote

I would recommend finding a position you're interested in and tweak your resume to match the requirements as much as possible without being dishonest. Have your skills align with the requirements. Most larger companies are scanning resumes looking for keywords and an actual person does not see it unless it passes the keyword test.

There are many, many different types of insurance jobs for nurses. NCRN I believe is describing a fully telephonic position - perhaps in disease management? I have held positions as a telephonic nurse case manager and a field nurse case manager for Worker's Compensation claims, a Nurse Life Care Planner (CNLCP), and also worked short-term and long-term disability claims.

NCRN is correct- working from home for an insurance company may sound like a dream ... and, depending upon the company, the position,and your manager it can be wonderful or completely awful.

You might try making a list of the companies that hire work-from-home case managers - look at companies of all sizes from Aenta and UnitedHealth types to Genex to Triune Health Group. Go to the company website and look at the job descriptions. Check the requirements. Apply, apply, apply. Match the terms on your resume to the terms used in the job posting .

I would not go back to working on-call, weekends, nights, holidays, etc. unless I was starving, however, this type of work has it';s own challenges.

Best of luck to you!

[Kooky Korky, BSN, RN]

Thanks for the info.

I am interested in working at home, too.

[C Roll 5, RN]

What made the difference for me was getting my CCM certification. I was already working as a hospital CM. My 1st remote job was complex CM. I did that for 4 yrs. Then went to a different company and did disease mgt. Not for me. Talking for 2+ hrs on the phone. Very similar to call center. Now I write insurance appeals. Working from home can be very isolating. A lot of nurses don’t like it. You have to be very disciplined. Some companies are very micro managing. Others are more hands off. Just depends.