case manager for large insurance company - clinical experience required?

[jlmanzano13]

Hello fellow nurses,

I recently got called for an interview for a position I had applied for - case manager/utilization management for a big insurance company. Qualifications, if I remember correctly, was to have at least 2 years case management experience without any mention of clinical experience. I applied to the position knowing that I have the required case management experience. I've been in the home health field for 9 years, and 3 1/2 years as case manager - receiving reports from nurses, therapists, social workers, approving visits, auditing patient charts, coding cases, developing the plan of treatment (485's), coordinating care with case managers from other facilities, etc... My current employer gave me the opportunity to work as a case manager even before obtaining my license, I started to train shortly after I started nursing school. My only concern now is that clinical experience may be required to even be a case manager (which makes sense). I'm surprised I was able to get an interview for this position. It's not that I don't have any clinical experience, I did note on my resume "clinical experience" offered from my school - injections, glucose checks, wound care, g-tube feeding, etc...

Is it possible to become a case manager with case management experience, but without actual clinical experience?

[elkpark]

I hope that you indicated v. clearly on your resume' that the "clinical experience" you were listing was from your student clinicals in school, and not clinical experience as a licensed RN. I would hope that significant clinical experience would be required, but, since your current employer put you in a CM position with no experience at all, it's obviously possible to get by without it, depending on the employer. Maybe you'll get lucky.

[jlmanzano13]

Yes I did note "clinical experience provided by my college". I even noted "observed catheter insertion"... HR manager told me that if the interviewer called me then she must think I meet minimum requirements and the fact that she gets at least a hundred resumes shows something, I had asked them to check my qualifications...