What is it Like for an LPN working for an Insurance Co?

skittlebear · Jul 12, 2010

Anyone?

gr8rnpjt, RN · Jul 12, 2010

OK here is what I know. You didn't specify what your current job entails, so with that being said, your "limited medical experience" could hurt your chances. They (mostly the blues) like general nursing experience like med surg. The bleus in most big cities don't care if you are an LPN or RN, they train you for what they need you for. You will be limited in which jobs you can take in the insurance arena, such as case management. you can't do that unless you are an RN but I hear that can change but you could be hired in Utilization management, They usually do preauths for inpatient an outpatient procedures and hospitalizations. LPN's with a good med surg background can be hired for that. If you worked in a Nursing home, you may do UM for SNF and rehab admissions.

That is general. There are other jobs that LPN's can do, but basically, mostly, LPN's will work in UM.

thekid · Jul 12, 2010

If you like monotonous office work, you will love it. I'm not sure what exactly your job description entails but you can anticipate telephonic assessments, and coordinating services for members. You will likely get a full lunch break, which is a nice perk.

I've been doing service coordination for five weeks and I am bored stiff. But..I don't like offices.

Other perks...company parties, weekly meetings usually with food, usually a good staff, no acute situations so none of the stress that goes with that. Decent working hours (usually M thru F), decent salary.

I had previous floor experience in ltc, hospice but what impressed my supervisor the most is that I am pretty good on a computer. The questionaires we use for our assessments are easy and you do use a bit of nursing background but honestly, most of my job is glorified data entry.

dcmckay · Jul 12, 2010

I am an RN and have worked in Case Management and Utilization Review for 3 years, after 17 years of direct patient care. I absolutely love the hours (M-F 8:30-5) and the benefits are great. I currently supervise LVNs who do utilization review. Working in the field is not for everyone. You spend most of the day sitting at a desk, reading a lot of clinical, talking to drs offices and hospitals, and documenting authorizations and denials. In my company, nurses do not deny ANYTHING. We only issue approvals and if there is not enough information to approve it or it doesn't meet criteria, it is sent to a board certified physician for them to make the determination. We occasionally even talk to the patient or patient's family. The first year that I worked here, I felt like I was in school again. I learn something new everyday and thoroughly enjoy it. The negative side is that you don't get direct patient contact and you sometimes have to be the bearer of bad news, when a surgery or hospitalization has been denied. We use nationally recognized standards and criteria, so it usually doesn't come as a surprise to the providers, however, patient's don't always understand. I hope this helps explain some of what nurses who work for insurance companies do.

KaroSnowQueen, RN · Jul 12, 2010

Insurance companies are looking for people with varied experience. I work for another major ins company, and I have worked LTC, hospital, agency, home health and private duty prior to this job. They also will change up your job.

At first I was doing discharge screening calls, calling the patients after they got home to see if they were getting their meds, if home heatlth was coming, etc. Then they switched me to UM, and I have done pre certs, concurrent review and now am looking over clinicals to see if pts who were inpt should have been obs instead.

I love this job, but I will tell you I was totally burnt out at the bedside, and have for the last five months worked from home and I am tickled stupid!!!! :twocents: :nurse: :yeah: :redbeathe

SRRRN · May 2, 2013

I know this is a little late by a few years but wondering if you could tell me the company(if still exists) you worked for. I like the idea that you could move throughout company into different positions.

ps don't mind my username, it was assigned LOL!

gmalauulu · May 15, 2013

This is exactly what I have been looking for!!! I'm looking to find an office job preferably with an insurance company. I currently live in Southern California and have been looking for a couple of months now, and have yet to find anything. Most jobs openings I have seen require experience in UM or Appeals or Denials, which I have none. I'm hoping that someone out there will be able to help me out. How would I be able to get experience? The qucikest way? I have been wanting to leave the patient care side of nursing for quite some time now but I can't find anything. Please somebody please! Any and all info is greatly appreciated!

NoriPlo · Aug 12, 2015

. .what companies are hiring LVN's for UM in the bayarea? I am looking for a UM position currently. .thanks for all the help nurses.