Field CM Agencies?

Rntr · Mar 18, 2014

I don't know about the agencies and yes, they were bought by Humana..

nurse8019, LPN · Mar 18, 2014

I was wondering if anyone could share their experiences working as a Care Manager and maybe give some insight into what a typical day is like in this capacity.

Rntr · Mar 19, 2014

The only thing I would say to anyone wanting to work for any insurance company doing "cares management" type work is not to stop you current position totally. Stay in a PRN position if possible. This is not what it appears... it's not a piece of cake. Lots of problems with this particular company. One day they won't pay for your license, "we have lawyers saying you don't need a license in any state to call" and then on down the road it's "oh, we made a mistake". It's your license people.... lots of problems.

You will hear people say, "this is the best job I ever had"... just keep your job on the back burner. You might be burned out there but you will get even more burned out here...

nurse8019, LPN · Mar 21, 2014

Thanks for the heads-up! :) I have a PRN job that I absolutely adore, and it would take something close to a miracle for me to give it up entirely-no matter how good the CM positions sound. You are right, they do make these positions sound super-sweet...

With that being said-is the licensure issue you are referring to one that would arise if calling a member in another state? Or maybe you are referring to liability/PUP insurance...?

Thanks again!!!

Rntr · Mar 21, 2014

Just went through this with the insurance company not wanting to pay for our license, states our "lawyers have checked this out and you don't need to be licensed in a state to call there" and refused to pay for license. Then they also mentioned we have talked to two other insurance companies and they don't require license in each state either. What they want is to not have to pay for the licenses nor do they want you to known as a "nurse"...etc. Just make the calls...

They have been called on the carpet about it... especially TX and LA. Many nurses started calling the different states and inquired about licensing and calling members there and were told to be license in each state or "don't call"... yes, keep your prn until you know if you can tolerate it.

Lots of issues...

nurse8019, LPN · Mar 22, 2014

I see! Thank you so much for your post-you may have just saved mine; I am now replaying convo's in my head, and have been oblivious to what is now a very obvious 'song-and-dance'. I hate that things are set up that way, but not enough to take part in something that could jeopardize my license. Thanks again!!! :)

nurseprnRN, BSN, RN · Mar 22, 2014

Just went through this with the insurance company not wanting to pay for our license, states our "lawyers have checked this out and you don't need to be licensed in a state to call there" and refused to pay for license. Then they also mentioned we have talked to two other insurance companies and they don't require license in each state either. What they want is to not have to pay for the licenses nor do they want you to known as a "nurse"...etc. Just make the calls...
They have been called on the carpet about it... especially TX and LA. Many nurses started calling the different states and inquired about licensing and calling members there and were told to be license in each state or "don't call"... yes, keep your prn until you know if you can tolerate it.
Lots of issues...

These lawyers are completely ignorant about nursing licensure-- or perhaps nobody even really asked one. If you are doing anything beyond simple "Did you schedule your appointment?" type questions (that a nonlicensed person could perform) when you call a member in another state, any question that has an assessment component ("How are you doing? "How did you do at physical therapy" "Who cooks for you?" "Are you having any pain?" and the like) you are practicing nursing and you must be licensed in that state. You do not have to be laying on hands to practice nursing.

pfchang · Mar 22, 2014

WellPoint (Anthem, BCBS) requires every CM RN to become licensed in every state you may be calling to. For some positions that is all 50 states but with Compact Licensure, you don't need to apply for licensure in all 50 if your state is one of the Compact states. But you have to apply for the rest and you start the process right away. They pay for all the licenses (they should) and have a department that works on this but it is still a very long process and takes months. You have to submit detailed info to that dept. If you have a problem with getting additional licenses, like a blemish or problem in your work hx, you can lose your job. Wellpoint will not allow you to call a member in a state until you are licensed in that state. I would not take a job that tells me it is ok to call members in a state I was not licensed in.

Rntr · Mar 22, 2014

Well, they are now doing a reversal and state "we will reimburse for your license" and now are rearranging many thousands of members that were dumped on nurse's without a license in the particular state the member lives in.

Yes, compact license and individual states that do not participate in the compact license.

Keep your PRN job and keep your eyes open. Do not make any remarks about anything you don't agree with to your coach (boss) or their boss. Any negativity is counted against you. Also, monthly meetings, they will say we would like to know what you think... don't tell them. Don't make suggestions. Keep focus on smiling and dialing if you want this job.

You will love everything there... coaches are not standardized. What one may want from you can be totally different from what someone else wants. You can't really listen to "this is the best job I've ever had" stuff and "it's wonderful here". Make up your own mind after there to see what the job is really about.

Rntr · Mar 22, 2014

Getting back to the original question... has anyone worked with Senior Bridge or any of the companies doing "Transition" care?

I would like some information on how they pay, is it per visit, is there any mileage etc.. thanks

Selfie · Mar 23, 2014

These lawyers are completely ignorant about nursing licensure-- or perhaps nobody even really asked one. If you are doing anything beyond simple "Did you schedule your appointment?" type questions (that a nonlicensed person could perform) when you call a member in another state, any question that has an assessment component ("How are you doing? "How did you do at physical therapy" "Who cooks for you?" "Are you having any pain?" and the like) you are practicing nursing and you must be licensed in that state. You do not have to be laying on hands to practice nursing.

Grn Tea, Do you know the governing agency for worker's comp and health insurance? Where would one report an agency for dubious practices ?