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Hospital CM vs Insurance CM

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by nurseyNJNYC nurseyNJNYC (New Member) New Member

4,139 Profile Views; 117 Posts

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Hello,

I am looking at choosing between working with an insurance company or a reputable hospital. Can anyone compare from experience?

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269 Posts; 6,800 Profile Views

I've done both and there are a lot of differences. The core similarity is they both involve discharge planning and utilization review. The big difference is the professional/social/political interaction in the hospital can get very complicated. I found that there are strong financial factors in the hospital setting which interfere with doing the right thing. Not so at all on the payer side.

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117 Posts; 4,139 Profile Views

Which did you enjoy more? They seem to both have their benefits.

I'm torn between wanting face to face patient interaction and interaction with colleagues, vs the possibility of more autonomy and remote work with the insurance.

I don't like to get bored easily and i love learning, but I also want my freedom and still have energy to attend to other things in life.

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269 Posts; 6,800 Profile Views

I loved hospital cm - it was fast paced, fully focused work and hours flew by, but was terrible at the politics and thus was unsuccessful at it. I do long term care CM for MCO now, work from home, lots of autonomy and no pressure. - but little intrinsic satisfaction. Looking forward to retirement soon.

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3 Posts; 161 Profile Views

It also depends a lot on your personality. Are you a go getter and always need to be moving? I work in Medicaid Managed Long Term Care. I sit in a cubicle all day long and review assessments with members, place authorizations for home care services, and resolve conflicts when needed. When I am not on the phone I have my headphones on listening to music or podcasts or whatever. If I need to get up an walk around I can. I do not punch a clock, we are all salaried. Some days it is boring and repetitive but then I receive my paycheck which is more than the local hospitals pay and I do not have to deal with the politics of the hospital. Sure I still get yelled at by patients but I can just end the call. It all comes down to do you enjoy working in loud, fast paced environments? Or would you prefer an office setting with quality metrics that you have to follow and state regulations that seem to change daily?

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