Field CM Agencies?

nurseprnRN, BSN, RN · Mar 27, 2014

As insurance carriers, work comp carriers are generally governed by laws and regs from the state department of insurance in the state(s) in which they cover companies and workers. They may also have responsibilities to the state division of work comp, if it's separate from the insurance commissioner's office. If the issue is nursing licensure, the state boards of nursing where the patients live would be the ones to clarify this policy for them.

Joyful68 · Apr 21, 2014

Jyes, keep your prn until you know if you can tolerate it.

Just check the compliance policies. I work for a different insurance company and in our annual compliance training they tell us that it is a violation of Conflict of Interest to work for an in-network provider. So, theoretically I could do PRN for an out-of-network provider, or I could go to work in a coffee shop, but, nah.

Our company doesn't pay for nursing licenses in our home state either, and actually in my 26 years of nursing I've never worked for an employer who did so I have never expected that. Overall, the law has covered as long as the nurse is licensed in the state from which she is physically calling the member, with a couple of states exceptions so they will cover licensure in those states IF my employment position specifically requires it, which so far has been limited to Arizona ( unless living in and calling from a compact state) and California, but they do anticipate that changing in the near future, and are planning to get us licensed for specific states accordingly though of course with the sheer volume that involves and at the rate things change, it will be put off until it is deemed absolutely necessary.

Rntr · Apr 22, 2014

I wouldn't encourage anyone to leave their present position permanently, stay PRN if you can by working once per month. Some insurance companies don't like this. Your decision.

As for license, if you are calling members in a different state than where you live, you need that license too.

It's not a matter of my opinion but the state boards that care.

If you have a compact license and are calling a state within the compact status then it's a no brainer.

If you don't have a compact license and are calling a state where you don't reside or have a license, call the state board of nursing where you are calling and ask them. No big deal and it keeps you legal.

I can tell you this, TX and LA both have said you better be licensed in their state to call any members there.

It's not realistic to expect to have to pay for all the license that you may need.

Yes, they should pay for them or change the states you call that you are licensed in.

fbesn · May 28, 2014

So what does Humana / Senior Bridge pay per hour for the phone calls to patients? Is it the same $150/hour they charge for a care manager to come to the home?

nurseprnRN, BSN, RN · May 28, 2014

So what does Humana / Senior Bridge pay per hour for the phone calls to patients? Is it the same $150/hour they charge for a care manager to come to the home?

Ah, no. Just as when a case manager goes to the home, s/he doesn't get that $150/hour, neither does the telephonic case manager get what the carrier charges the customer for the call.

When I did field case mgmt my first company charged our clients $85/hour for my time, and I got $32.50 (this was a long time ago).