Insurance Case Management

gonzoRN, MSN, RN · Dec 2, 2016

See below...

Hello. Does anyone work as a work at home case manager for an insurance company? Yep.
If so, how do you like it? Best job ever.
How was the transition from bedside nursing? Not difficult at all. My caseload is predominantly critical care, the bulk of my career was in critical care. It's like being there, without being there. If that makes sense.
Do you see yourself doing it long term? Till I retire, guaranteed.
How is the pay? Excellent.
Are the productivity requirements realistic? Couldn't say. My particular job/department/company doesn't hold our feet to the productivity fire, which, I venture to say, is outside of the norm. On the other hand, most of my team put in more than 8 hours a day, sometimes much more...
How was the training process? Low key. I spent approx 10 days learning the systems, worked directly with a peer for another week, and then jumped in with both feet. Working at home takes focus, the ability to adapt, and focus, and the ability to work without constantly getting direction. If you're easily distracted, it'll be damn hard. Did I mention focus? As in nothing in my house exists while I'm doing my job. Unless there's a fire :)
Any information would be greatly appreciated. Make friends with the techs, your assistants, whatever your company calls them. They know everything, including how to keep you from making a fool of yourself. I learned more from them about how things actually work/get done than my RN peers.
Thank you!

TheCommuter, BSN, RN · Dec 7, 2016

I have been a work-from-home RN case manager for approximately one year. I thoroughly enjoy it to the point that I would prefer to not return to the floor unless I faced immediate homelessness.

The pay is slightly less than what I earned when I worked the floor, but the boost in my quality of life and reduction of stress levels makes the pay cut worth it.

The training was disorganized and done in a baptism by fire manner. However, the productivity requirements are very manageable.

sunshines66, BSN · Dec 18, 2016

I love my case management job. I work mostly 8 hour days. Occasionally it will go longer if I am in the middle of a conversation. I can start or stop an hour or so earlier or later without consequences. I have productivity goals but have been able to meet them so far. I got close to nothing in terms of orientation. I did some on the beginning aspects but then none when I was actually making calls. We had no hard and fast rules at the beginning. Now getting new rules by the day.

I am at a stage in my career that being hands on is not that important anymore. I worked 27 years hands on, lots of overtime and lots of challenges. I worked ICU, telemetry, emergency, with a spattering of admissions, cancer care, gen med surg, ortho thrown in to keep me on my toes. I worked a full-time job and frequently had an agency job as well.

I plan on ending my career with this job. As a nurse, I have not always had good retirement benefits so I will be working until my full retirement age and possibly longer. I have at least 18 more years of working to do.

Pay- well it is equal to what I was making in my last job that was heavily into travel. The benefit package is great. It is much better than when I was doing hospital work. Having no holidays or weekend work is awesome along with it is a day shift position. If you have specific further questions just let me know.

NikiRN88 · Dec 19, 2016

Thank you very much for your responses. I was offered a work at home position with an insurance company and I am nervous/excited about it. I am nervous about leaving my current government job mainly. I don't dislike my current job, but the politics are draining. I work as a case manager at the VA currently so I'm already Mon-Fri no weekends or holidays, but working at home would be ideal. My friends and family advise me to stay with the VAMC especially for retirement and benefit purposes. I feel like I am too young to limit myself to one place for the rest of my life.

SnowyJ, RN · Dec 31, 2016

I am going to jump in and say I made the change to work at home CM for an insurance company and honestly, I don't love it. BUT that could be because my job is VERY production/quota based. I am tied to a wired headset all day. The calls are constant, and every minute is monitored by admin. Even if I take a bathroom break, it counts toward my pre scheduled 15 minute break. Once all my calls are monitored, and I am evaluated monthly on "quality" (i.e. How many calls I can make and how productive they deem it to be.)

The truth is, I miss clinical nursing. I feel like I work in a sweat shop. I think it's the nature of my particular position. I have friends that do CM and are under much less pressure/micro management.

The pay is good. That's one plus. But the truth is I feel isolated and under constant pressure to perform. Not sure how much longer I want to do it. I'd like to at least stay a year.

kembers · Mar 27, 2017

i actually have some questions. are they easy going with getting vaca off - unpaid time off? how do you do dr. appointments or dentist appointments for yourself working 9-5 ? are you on the phone all day long, is the company up your butt about constantly doing stuff or how do they know if youre inactive or anything like that? or is it just get what you need to get done and dont worry about the hours? (i mean everyone needs a bathroom break..) do you need to have a bachelors degree to work for an insurance company ? (i currently do case management for home health and would like to transition eventually)

TheCommuter, BSN, RN · Mar 28, 2017

are they easy going with getting vaca off - unpaid time off?

I have never had any issues obtaining the vacation time or PTO I request.

how do you do dr. appointments or dentist appointments for yourself working 9-5 ?

I go to appointments in the middle of the work day. I simply work my personal life into my work day. As long as the work is getting done, it is alright.

are you on the phone all day long, is the company up your butt about constantly doing stuff or how do they know if youre inactive or anything like that? or is it just get what you need to get done and dont worry about the hours? (i mean everyone needs a bathroom break..)

I have gone weeks without placing or receiving a work-related phone call. However, case managers at other companies seem to deal with more micromanagement.

do you need to have a bachelors degree to work for an insurance company ? (i currently do case management for home health and would like to transition eventually)

I have a BSN, but more than half of my coworkers are associate degree nurses.