Nextcase

GrnTea that is the point Exactly the employers should be aware so if they are not telling their employees this fact are we to assume they are willfully skirting the law? What agency would have oversight over the employer following this law and not putting employees at risk? That is why I am interested to know if there are nurses doing telework that are not aware of this fact and worse yet not being told by the employer.

Check with your state BON. If you feel you can't give safe and effective care then you can refuse any assignment. In addition you may very well have a duty legally to report neglect and abuse. He lives with others and this situation could very well fall under those headings. As far as going in and not taking any critters with you when you leave, you would have to disrobe before getting in your car or risk infesting it with bed bugs.

Thank you elpark i appreciate you condensing the facts surrounding my question. I want to know though how many CMs are working across states lines that did not know or were not told by their employer they need additional licenses. So telework nurses, did your employer tell you this is the law? If not, have you asked about the legality of what you are doing?

I am interested to know if nurses working from home are informed by their employer they need additional licensure for out of state cases under certain circumstances? Did your employer pay for getting or renewing all licenses? My curiosity has been aroused after a recent discussion with several other nurses all working from home each with a different insurance. The subject came up when one nurse mentioned she was having to get another license because of a new group of cases. Some live in compact states and others do not. Several from compact states with cases in non-compact had to be licensed in those states. One nurse in particular was in a non- compact state and had cases all over the country. She consulted her board of Nursing and was basically told what she was doing was practicing without a license in those other states. It goes without saying she is upset and was not aware of this issue. My advice was for her to discuss with her supervisor. Well she did and it did not turn out well, so she is looking for another job.

I tried to answer you private msg. Typed a big long reply and when I hit send it said I was not allowed to send private messages..sigh and deleted it...sigh. Any way learn the WC reg inside and out, and work well with the adjuster. I LOVE the fact that in your state the laws say a case manager has to be paid hourly!

You can telecommute with Aetna and do UR, I believe they still require you to start in office. AHH (owned by Aetna) will start you at home right away after training in Ohio. Many of the UR nurses moved to that from the CM side. Some are CCM and others are not. Ahh is very short on UR nurses presently and they started the year by requiring the CM staff to help UR during the week, they are still asking for volunteers from CM on weekends. Aetna has a significant higher pay scale across the board for nurses than AHH. This came to light earlier this year when two sister were hired, one with AHH and the other with Aetna. The one with her CCM and experience was making less than her sister with no CCM. Have you done your own UR as a hospice CM? That will be a big advantage if you have. They use Milliman, plus internal guidelines. I do complex catastrophic CM and do my own UR on those cases. i want to take this opportunity to thank your family for their service to the country! I know that it is not just the enlisted person that has to make sacrifices.

Mmlils30, I know of some CM doing 10 hr shifts at AHH and Meritain which are part of Aetna. Reality is that since it is salaried position many scheduled to work 8 hrs are working 12-14 days and some weekends. Case load is 50% higher than what is told on interview. Aetna 'proper' many be different with shifts, it never hurts to ask! Aetna 'proper' does not work on the billable hour model like the other two do. With billable hr. A nurse schld to work an 8 hr shift is required to bill 9 hrs. Does not work out well since many things the nurse does is categorized as non billable time by the company. On the yearly review you are marked down if you are not billing over 103%! So, be clear and make the recruiter put specifics like shift and case load in writing.

I did worker's compensation cm for 5 years. I am now in another speciality. In some ways it was better because the adjuster has a lot of control over the decision to pay for something. I had an adjuster agree to pay for a surgey the medical reviewer denied. In others it is very stressful and you have to guard against becoming suspicious of every claiment because of the few that work the system. As far as salary goes with aetna you need to negotiate. The people that do the screening process for them will give you a low ball offer, you need to counter a bit above what you want and in the end come down to what you actually want. Example 5 nurse show up for training, talk over dinner all got rediculous low offers IMO. 2 of us negotiated to much higher pay. Good Luck and pm me if you take the job!

Stand your ground on not taking a pay cut. They generally use an outside recruiter and they lowball everybody and say they will not negotiate.... Good luck!

@been there.... Perhaps "stuff" was not a word choice to your liking? How about I phrase it as finding the appropriate criteria based on the clinical documentation supplied by the physician or facility? I do complex CM and I do my own UR on the patients I have in LCM, therefore I work in two separate areas in the same system. What nursing judgement has to do with the UR process is understanding the complexity of the disease to be able to know the appropriate criteria to employ and interpret that into a medically necessity review. BUT the bottom line is if the 'stuff' does not meet the cookie cutter hole of milliman or interqual etc. I can't say per my nursing judgement I will cert it. Nope, I must say I am sending it for a physician review. big bucks, are in the eye of the beholder when they check their pay stub :-)

I would say the interqual had a short learning curve of less than a month because it was basically check a box and get a green or red light. Milliman took a good 6 months to really be able to find stuff fast and write the rational.

That sounds more like a QA job to me for sure not actual CM. In our organization all of our QA reviewers that review the CM documentation are RNs and most are also CCMs. I hope that you have a tough skin, because you will need it in this position...... :-)

I don't do Medicaid. However, I do complex CM where I handle both the CM functions and the UM side of the case. First is it the actual review of records or the software that is confusing you? I am guessing it is the second and your learning curve will be dependent upon to a large degree how fast you can adapt to learning new software. My first experience was using interqual and then I had to learn Milliman. Each can be searched by the dx or procedure code. Then it is just a matter of looking at clinical to see if enough criteria is met for nurse approval. See if you can attend a training webinar for the software, that will certainly not hurt. Of course after those I also had to learn to use lexicomp and the NCCN criteria databases. Hang in there it WILL get easier and faster!

It is a fallacy that when you work from home you "set your own hours". In fact you will probably work more than your scheduled hours, especially if you are salaried. They have many ways to monitor when you are supposed to be working, right down to your keys strokes and mouse movements or lack of those. Some employers records all calls and then they are listened to by the supervisors to produce a monthly audit score that is used as part of your yearly performance review. If you have small children you must have somebody take care of them while you are working and on the phone.

facts about AHH. They pay much less than the Aetna pay scale. You are salaried and paid based on an 8 hr day...but are required to post 9 hrs of billable time each day and lots of your day is taken up by things you can not bill. So that translates into much more than 8 hours per day. In addition you are required to attend meetings that can run over a hour and are still required to meet the billable quota for the day. If you are not making 100% of billable or above your information is sent to all your peers on a report each week via email. Average CM case load is above 60... Way more than the 40 they will tell you in the interview. The turn over rate at AHH is very high. Expect to work lots of nights and weekends for this company with no positive feedback or support from management.

Mersekrn, I thought I posted this but not sure where it went :-). I see you are in OH, do you work directly for Aetna or AHH ??

Mersekrn, I see you are in OH do you work directly for Aetna or are you an AHH employee, under Aetna?

Is your interest in a job with Aetna or possibly a company it owns called American Health Holding? Aetna has a much better pay scale than AHH and cm leave AHH at a very high rate