Published Jun 25, 1999
I am an RN who is looking for employment that is not a direct pt care environment. I have been looking for employment with insurance companies or bill review related. Anyone have any ideas regarding special classes that I can take to make me more marketable?
Hi Karen, If you live in a large community, consider going to a case managers nursing meeting. I did some case management and it was basically a job I fell in to through knowing other people, but larger cities will have case management nursing associations and that might be one way.
You could just try some letters of introduction at targeted insurance agencies, telling them your qualifications and strengths. Blue Cross and Blue Shield in our state uses nurses in a variety of roles and so if BC/BS or the equivalent is based in your community try them. Often insurors for workmen's comp will employ nurse case managers to keep cases moving and you might try a letter of intro to those companies. Case management requires excellent communication skills, excellent problem solving skills, and the ability to think in a business like way. Insurance companies will rely on you to either tell them what is reasonable care in this case or enforce care policies and so "know what good care looks like."
If you're considering working for an insur-
ance or billing company, you will need some
background in ICD9 coding (Dx codes) & in
CPT4 coding (services provided). Your comm-
unity college should offer these courses.
Good Luck! Pat G
Let's see. There is UR, QA, QI and case management as well as legal nurse consultant.
You will need experience in all of these areas before you will be hired. Community colleges have good CEU's usually in ICD-( and CPT-4 coding which is invaluable and if you can find a case managment class that will help. You can also take a class to become a certified worker's comp claims examiner or a certified professional disability manager (CPDM) and that will give you a leg up for getting into case management in worker's comp or insurance. As for legal nurse consulting. There are several classes that you can take which are all home study. (AALNC) American Assoc. of Legal Nurse Consultant's has a video course for $800 and Medical Legal Nurse COnsulting Institute has a course for $1800 and Kaplan's NIPAS has a Paralegal legal nurse consultant class for $2995. They are all good and of course wherever you have business, they will say they are the best. It depends what you are looking for. So I hope this has helped. You can get on the web and look up legal nurse consulting and nursing case management for links.
Read this old thread. But I would add more to the info mentioned above. For those interested in this specialty - there is a national organization for medical auditors - The American Association of Medical Audit Specialists. Their certification for those who successfully pass the exam is called CMAS = Certified medical Audit Specialists. website: aamas.org
Blue Cross in Michigan hires RN's in different capacities.
Mainly the requirement is 5 years med/surg experience for an entry level job such as in the pre-auth area. Other areas available are a utilization type of work. Also Blue Cross has a call-in health line that they hire RN's for.
There is a web site http://www.BCBSM.com that you can check for available positions.
Hope this helps.
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