Butterfly80RN

Hi, I'm looking for more insight as a work at home pre auth nurse. It would be review of cases for medical necessity. It is for a smaller company and I cannot find much info on it. A friend of mind works for a large insurance company doing the same thing. She has a laptop and has no problem completing her cases. She is also rarely on the phone (which I really like!). Anyways, they're not ever hiring! She has showed me what she does. She pulls from a bank of cases for pre auth, opens the members benefits coverage, compares it to what the member is needing and submits an approval or denial. I'm full time and need part time. i currently work as a Care Manager for a large insurance company and I can't stand it! I'm on the phone all the time attempting to talk to people who have no interest in speaking with me. The focus on numbers, percentages, talk times, call audits is overkill to me. Absolutely no autonomy. I rarely feel useful as a nurse and more like a telemarketer. I have aver read mixed things on pre authorization. I'm looking for others experiences. Thanks!

Opps, typos.

Hey everyone, thought I would put in my 2 cents. I have been working as a care manager for about 4 months. This job definitely has it's pros and cons. Depending who your coach is will also depend on how much you will enjoy your job. Unfortunately I was not lucky. My job is very micromanaged. Everything is monitored, your computer, calls are recorded, your coach will no when you are on the phone or not. Also, your coach and break into your call while your on the phone. Don't ever ever use your phone for chit chat! Remember calls are recorded and your calls will be audited by your coach and a audit team! Everything is based on numbers and percentages, how many members you have called, how long were you on the phone for the week, how many surveys have you completed. You end up having to call more members then the 10 a day they tell you and this is because you will not reach Hal of them in the beginning. Remember they want to to at least contact 70 percent. I usually end up making about 300 calls a month and still don't reach 70 percent. There are a lot of phone and system problems that put you behind. I do not work more then 40 hrs but I know others that do. This job may be great for others who enjoy talking on the phone. Sometimes it's rewarding but usually all you hear about is how these members don't have money to afford anything. So you refer them for help and then they are told there's nothing that can be done. It's also like telemarketing (in a way). Sometimes members get upset that you are calling.... i think it's great if you don't have a family to worry about and you don't mind being on the phone all day. I think the pay is great for what you actually do. This job is not for me and I will be looking too unfortunately. I feel like this job lacks autonomy that I used to have. The great thing about this job is I can flex my time if I need too because of my kids schedule or doctor appts. You just have to make up that time during the week. There's no half days. I'll be happy to answer any questions.

Hey multinurse, when are you doing your training? I start in a week! I have received a ton of emails so far.

Thanks for the response....whew! I will not be doing utilization review but will be working as a case manager. I'll let you all know how it goes! It will be straight Wah with virtual training. I'm told the stress level is much different then bedside care so I hope it is for me! Thank you so much for your input!

I'm going to be working from North Carolina. How would you say the stress level is? I'm coming from a high stress neuro floor and want to get away from it! Do you like it ok? Is it boring or something?

RN in Fl- how do you like Humana so far? I will be starting soon.

Hey, I was wondering if you are going to be working for Humana? I just accepted a position there. I'm really excited about it but nervous.

Hey Dianne, I'm curious if you accepted the position with Humana!

I had the second interview and accepted a position. I had a very positive vibe. I'm excited to try something different then bedside.

Bakela-How did your interview go? I have my video interview Friday. I'm nervous and excited to try something new. Tddnurses- Are you a case manager? If so, do you find you caseload manageable?

Did anyone take the job at Humana? If so, have you started? Like it? I interviewed today.