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Discussion

Metrics

What is the requirement for metrics that is required by health insurance companies?

I work dialysis, and in this area, nurses are challenged to maintain Medicare and End Stage Renal disease goals. These goals require the adjustment of medication and dialysis prescription per algorithms, education, changes in plans of care to meet established goals. Is this the metric that is expected by companies like United Health Care or Blue cross.

I'm thinking of applying for one of the case management jobs. Frankly, a high volume of calls does not bother me too much. But trying to make a non-compliant patient meet goals without their cooperation or will would drive me nuts.

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    Metrics is how they measure the calls. It can be tricky you have to follow the guidelines the company sets for it. I did not like the metrics at UHC.

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    Are metrics related to the number of calls a nurse responds to such as one call every 10 minutes? Are metrics related to recruitment of the insured for certain services such as flu vaccines, case management follow up, or something else? Sounds like there are guidelines to follow to meet metrics, can you provide an example? Mostly curious, hiring for UHC and other large healthcare providers are slim in my area, although, I have my eye out for one. Thanks You.

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    At UHC you make the calls. Metrics are related to the number of calls contacted ( not called) you could make fifty calls and only reach 5 people. It is also related to the key point that the company requires you to make on those. calls.

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    Interesting. Thank You.

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