Insurance case manager

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I'm looking into transitioning out of the bedside to case management. I like the fact that eventually it can transition to an at-home job. Can a current/former insurance company CM tell me some of the pros/condo the job?. Any thought? Thanks

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No one?

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Specializes in corrections and LTC.

Sure wish you had rec'd some replies! N

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Specializes in Med/Surg, Ortho, ASC.

I've never been a case manager but I've investigated the position a couple of times. What has kept me from going there is my concern that case management may not exactly be considered as advocating for the patient. Having been at the mercy of insurance companies a few times (actually had to sue one to get benefits), I am keenly aware of the enormous role that insurance companies play in making our day to day medical decisions (pharmacy "tiers", HMO gatekeepers, etc.).

I'm just not sure as a nurse that I want to be on that side of the equation.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

thread moved for best response.

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Roser that's was one of my concerns as well.

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Specializes in Care Coordination, MDS, med-surg, Peds.

I am a telecommuter CM and an RN, for a large insurance company. I work from my home. I do computer form filling, and faxing, emailing, and go to members homes to do assessments required to determine the best use of their insurance benefits and explain these benefits to members.

I do education of various components and work with therapist, hospitals and Doctors to do the best we can for the member. I enjoy my work.

Its a good mix of computer stuff and actually having time to talk to members!!! I do not do physical assessments, wound care, any type of care that involves actually hands on care. I do utilize my nursing skills in observation, therapuetic communication and other non-hands on skills, you cam think of.

Other nursing jobs for insurance may include reviewers to approve/deny services and treatments.

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