Renaylor

I work at a Long Term Care facility were there are approximately 800 residents and about 125-150 have managed care policies, the rest are Medicare/Medicaid. Of those 125-150 I actively follow 30-40/wk which vary from month to month-sometimes more,sometimes less(and about 10-15 residents are monthly(Guildnet) spread out over different days during the month.

I work in a Long Term Care setting in an office with just myself my managed care coordinator and a Director who oversees the whole operation. My coordinator handles Managed Care from the financial end:levels and negotiation. I am the only Managed Care Case Manager for the facility and I am responsible for Clinical Reviews sent to the insurance companies which will determine continuation of coverage by the insurance company,conversing with other case managers for the insurance companies, and teleconference calls for a specific network of patients. I just got into case management due to burnout from 14 yrs in Geriatric acute care. I lucked out and found this job in Nursing Spectrum. Thankfully it is also 10 minutes away from my home and my little girls school, the benefits and pay were comparable. I am sure you responsibilties may vary, I am sure you will have some type of coordinator overseeing the operation and you will likely be reviewing cases that have been documented and determine if coverage will continue. You will love the autonomy. The stress is minimal(compared to working as a staff nurse in a acute care Geriatric Medical Unit), and I finally feel respected for what I do. I may not be working directly at the bedside but I feel as if I still make a difference in a residents life. You will also find that your diverse experience will really help you with your decision making and documentation(Nurses after all are great critical thinkers!). It may be scary at first but you will adapt..Nurses always do and you will do great. Good Luck!