For nurses who work from home

MatrixRn · Jan 25, 2015

I have friends who do and even if they manage their time well they often end up working a lot of hours.

This would not be bad for folks who want overtime but often CM is salaried.

My friends tell me that it is expected that they have a certain amount of cases completed per day. Period. Irregardless of how long it takes.

thekid · Jan 28, 2015

I am not an office person and feel confined in a cubicle so CM work has not been exactly an exciting job, but I was able to maintain some flexibility. I can only relay my experience working first for an insurance company and then as a psychiatric case manager. Both required face to face assessments so I was not at home every day. The insurance company job was a bit more flexible and independent but you had to keep on top of the caseload. Many of my phone calls were dealing with care plan members who were unhappy when the insurance company changed benefits or increased a co-pay (understandably, but who wants to be a punching bag). Frustrations included having to follow up to make sure 1147's had a doctor signature (and were faxed back), chasing down DME and auth forms, and being very aware of the many ways that the company could improve (for example having an intern do some of the signature chasing so that the RN's could do more focused assessments of needs). Staff meetings were once a week and were more a formality to make sure we didn't leave the state because honestly, any news or changes could have been emailed to us. I was easily frustrated and bored at staff meetings because they would extend beyond the one hour time frame because some employees used it as their social hour and asked the same questions weekly. Case managers were the first ones to be blamed and that was tough. Our company had a list of high utilizers (patients who had multiple hospitalizations) and we were constantly pressured to perform miracles and prevent readmissions (and this can be tough with noncompliant patients). It felt like a numbers game instead of a quality measure.

Psychiatric case management .. my phone would start ringing at 8 am. On. The. Dot. Patients are VERY needy and this company had a high turnover rate of nurses. Many patients had worked their way through multiple case managers and request a new one if say we were out on another call and we could not pick up right away. Truly a thankless job. I was told the hours were flexible but what they meant was..which 50 hours of the week do you want to work. I never felt the job was done and dreaded Mondays because of the phone messages that piled up over the weekend. Again everything was the case manager's fault. The caseload was challenging because we had to see a certain number of people per week but urgent matters always came up (a member would call the crisis line or would be discharged from the hospital early, or hell was breaking loose at the group home because the patient was caught stealing cigarettes). The unlicensed CM's were paid according to the time/hours spent with a patient no matter if it was an intervention or just helping them finding the right bus to take) whereas us licensed CM's were paid per person no matter if it was 15 minutes or 15 hours. This confused the patients and resulted in inconsistency of expectations and boundaries. I spent 20% of my time as a nurse.. the rest was personal assistant. Case manager became synonymous with "someone who will drive me around and do what I can do for myself or I will file a complaint." Yeah.. I know the members were mentally ill but I also think as part of being in the CBCM program, that members should make an honest effort at independence (when possible) and rehabilitation. I'm sure I sound jaded. I have never in my life had a job run me into the ground so much. And I really enjoyed psych.

Anyways, if you live with anyone, just because you work from home doesn't mean they will take your job serious. You will be constantly interrupted even if you are on the phone in an office room.

One positive is that if you are feeling under the weather, you don't have to necessarily take a sick day. You can bump your appointments and work from home.

Pay and benefits vary. The insurance company had a pretty good benefits and paid time off deal (and sick days), we were given a laptop and a cell phone, and paid 50 cents on the mile for travel.

The CM position in psych..I don't know if it was just the company I worked for but you didn't earn any vacation days until you completed one YEAR of work (they knew there was a high turnover). You didn't want to take a sick day because of all the irate phone messages you missed. We used our own computers and phones, and were not paid for mileage which was terrible considering how many times we had to play taxi for patients who were perfectly capable of taking the bus.

I won't even get started on the amount of flack we received from the insurance company we contracted with. Fingers pointed at us. If our high utilizers went back in to the hospital for SI, it looked poorly on us. I had patients who used the ER and psych unit as a way to get free room and board when it was raining so I'm not sure what nursing intervention in the world could prevent that.

I have successfully reminded myself why I quit psych CM.

luvsfallin · Jan 28, 2015

Thanks! Very thorough description!

SummerGarden, BSN, MSN, RN · Feb 1, 2015

The CM position in psych..I don't know if it was just the company I worked for but you didn't earn any vacation days until you completed one YEAR of work (they knew there was a high turnover). You didn't want to take a sick day because of all the irate phone messages you missed. We used our own computers and phones, and were not paid for mileage which was terrible considering how many times we had to play taxi for patients who were perfectly capable of taking the bus.

I went through the same thing and I doubt I worked for the same company. I too will never, ever, ever, work Psych CM or outpatient Psych ever again!!! In fact, one of the hospitals I work for received a grant, but lost their CM who implemented the grant because of the high demands from the patient population she was working with...

A nursing recruiter begged me to take the job knowing that I am interested in a positon that is a promotion of management or will lead to a promotion of management. The recruiter saw me as enticing due to my background so the recruiter tried to re-package the position as one of leadership, where I may end up running the department. Although the hiring managers were requesting a leader in the nurse they want to hire, they also want someone who understands that the position translates into "who ever takes this job he/she will have noone to help but will be responsible for the errand running/waitress acting aspects of the job along with the some of the nursing aspects of the job!!!

Fortunately, experience has its privileges!! Not only can it land us jobs, it can help guide us in our decision making process as to what opportunities to turn down immediately! :) Good luck!

mommieNurseRN · Feb 14, 2015

I work from home and I love it. I'm required to open a certain amount of cases per month but its usually not a problem.

"I Can Do All Things Through Christ Who Strengthens Me"

Philippians 4:13

KourtneiNurse · Feb 14, 2015

I work from home and this is new for me. I never truly clocked my hours but I imagine I work 35-45 hours per week. My children are young but I still take them to daycare. For winter break when schools and daycare was closed for a week, they stayed home with me and my husband and I coordinated our schedules.

Time management and being a self motivated individual is a must. Someone who is organized and ultra driven could probably be a rockstar at my job, but the nature of work is not based only on your efforts...anything dealing with patients, especially patients with adherence issues, leaves room for the chase.

My company monitors my productivity with morning meetings and evening reports. Of course I have a quota of 50 cases and I'm sure they can fully monitor how often and when I log-into their web site. I have not met their quota yet and the pressure is definitely on!

I worked in management before this job and I made my own schedule with that too, but I must say, I am enjoying being home. My pay is pretty good but I am salaried.

overtonis · Mar 1, 2015

can this be done on part time/per diem basis from home? I already run a company and do one night week in ICU as RN. I am always looking to add revenue streams for my family. Has anyone come across per-diem CM that can be done from home?

RN In FL · Mar 2, 2015

can this be done on part time/per diem basis from home? I already run a company and do one night week in ICU as RN. I am always looking to add revenue streams for my family. Has anyone come across per-diem CM that can be done from home?

I worked with Humana, WAH, UR/CM. It is totally a FT job, from my experiences, WellCare has PT WAH positions. Don't think the Humana's or the Aetna's do. After all the hours I put in, working at home, I probably was making 10.00 to 11.00/hr. They get you with "salaried". But don't let you work your schedule accordingly. No overtime or comp time. Will never do it again

vegnurse21 · Mar 28, 2015

I know I'm pretty late to this but I would be interested in finding out where some you all that hate working from home in CM are working. I work from home w/insurance and LOVE IT. I don't have kids but even if I did I would definitely have to arrange for child care because well, you're still at work!!! You can "set your own hours" in a way, but if it's telephonic then you kind of have to go with the patients schedules. I would be angry w/7:30am calls to talk about my heart failure lol.

So we mostly work 8-5. I get a break up to an hour as long as I'm clocking my 40 hours a week and they are productive (i.e. no starting the day at 7 because what can you really get done?). Yes productivity and metrics are the name of the game for the most part, but isn't that everywhere? You go to the hospital and it's the same thing.

I help people, I work from home, I work out on my lunch break, my dog can snooze by me as I work, I can go potty as I please lol...this is truly a dream job.