Interested in case mg from home

nurseprnRN, BSN, RN · Apr 25, 2013

You need to know a lot more about what they're offering. Most insurance companies don't want you to be working from home until you have worked in-house for a few months so they know you know what you're doing and won't be spending your "work" hours at the spa.

But assuming this is what they mean, telephonic case management involves keeping tabs on a case load of patients, keeping up with their treatment and physician appts, getting the notes from treating MDs and therapists, facilitating care to avoid delays or duplication (see below), and reporting on each one monthly (or more or less, depending). You would get a computer issued to you, sign in to the company computer system every day, and do your documentation and reporting there. It tracks you to see that you are doing what you need to do, but you aren't usually limited to 9-5. Many people work "mother's hours," and finish off their day's documentation and whatnot after the kids are in bed.

Field case management may also include traveling to see people in their homes, attending their office visits to get updates from the treating clinicians, and working with the patients and the treating team to make care more effective and efficient.

For example, if a patient has knee surgery, you attend the preop office visit and ask when PT will start postop. The doc tells you he will see the patient at 10 days postop and PT can start after that. Because you asked that, you schedule the first postop PT eval for the day after the postop office visit right away, not after that postop visit, because you know that the first available PT appt will be two weeks after you call. If for some reason the MD chooses to delay postop PT at the postop visit, it's easy to reschedule because the patient is already in the PT system.

floridaRN38 · Apr 26, 2013

Thank you. Sounds pretty interesting

thekid · May 2, 2013

Depends on the insurance company you work for, I can only speak for mine. It's based from home but we do travel to the office at least once a week, and home visits can range from 5 to 10 a week for new enrollees or complicated post hospital discharges. We also do quarterly visits for our more medically fragile members.

I took the job to get a foot back into nursing , and while I do use nursing assessment skills, I feel more like a customer service rep than anything. Most of my walkie talkie's require an annual call to check in with them and usually that goes pretty smooth. I prefer working with discharge coordinators from hospitals to help place members back in a home setting because I can use more nursing skills.

I'm considering going back to facility care. Working from home has its benefits if you are self directed. It can be flexible on a schedule with kids. But honestly I'm bored with it and I don't have the burning desire to learn more about insurance..it's just not my interest. I may have a change of heart once I'm back on the floor though :)

AGain only speaking about my experience in my company but prepare to hear a lot of complaints from members. Prepare to deal with problems with providers no longer accepting new patients and spending half a day searching for a provider who will. Prepare to hear from doctors who refuse to work with your insurance plan due to claims and not being paid. Prepare for long waits for DME ..scripts that sit on the desk of DME vendors, or auths pending , I could go on but the process for helping someone get a wheelchair can sadly take months. I don't blame that time frame on my company. I think it's difficult to coordinate with vendors when they have a process, we have a process, doctors aren't sure where to fax scripts, etc. As a result nurses and social workers spend a good portion of the day chasing papers and then hearing complaints from all sides.

But perhaps working for a different insurance company would have an improved process flow. The pay is alright but I feel a prisoner to the computer and phone. Some weeks are light but the heavy ones make you pull your hair out.