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Yes, that is true with all telephonic UR positions. My company does the same thing. There've been times when a nurse was stuck on a call for a really long time so the sup listened in on the call. However, this is usually to help the nurse stuck on the call. The sup will send her a message telling her what to say or do or, if the person is irate, tell the nurse to transfer to her and she'll handle. Incoming calls handled from the queue are closely monitored(includes call handle time and case completion) as well as the number of cases completed. This info is available in real time. In other words, if you're working from home and did one case at 9 and surfed the internet until you did another case at 11, you can bet your sup is going to see that and call you out on it. Of course, it all depends on how closely you're being monitored on any given day. He/she may only check production at the end of day for one, but periodically check for another if he/she knows that individual tends to slack.

Hi. I'm sorry to hear you're having such a rough time. I'm still confused, though! If I was accused of being impaired and a safety risk and I knew it to be completely unfounded, I'd have my attorney all over them in a heartbeat. I feel like I'm missing something. I see you have been battling depression. While it may be hard for those not battling depression to understand, I completely get the call-outs and not responding when being on call. Depression sucks the life out of you. Taking a shower even becomes a chore. I suffer as well. It the presumed impairment but due to Ambien and/or lack of sleep, have you any recollection as to what you said or did that made you come across as "impaired?" I know I'm asking the same questions others have, but again, it seems to me that a huge piece of the story is missing. As far as Ambien - here's my 2 cents. I don't have personal experience with it, but I have heard some stories. As with any med, I'm sure it does what is intended for some and messes with others. My Grandma stopped taking it after she woke up without her underwear on and couldn't find it in the usual places. She never did figure out what happened to them. :) Best of luck to you.

Hi! I've never done case management, but I currently work in prior auth for a major insurance company. I only did beside nursing for 3 years before I started, so obviously had zero experience and absolutely no knowledge of insurance. I honestly am not sure why I was hired. Perhaps there were a lack of applicants at the time because I really was clueless. I picked it up quickly, however. I do have one question. When you applied for these positions, were you given any sort of knowledge test by HR at any point during the interviewing process? I only ask because I had to take one. If you were given such a test, how do you think you did? Maybe they hired the other candidates because they had insurance experience or knowledge than you. Also, I know that most insurance companies prefer a BSN for case management. Not sure if you have it or not, but if you don't that may be a reason as well. Best of luck!

Wow. One of the main reasons I never went into pediatric nursing. I was able to detach myself when caring for adults. I don't mean detach as in cold and unfeeling, but able to pull myself together to continue to care for the next patient. I don't think I could do what you do. I read this story aloud to my husband who is a physician and used to work in the ER many years ago. After I read this to him, he shared with me some horrible, horrible stories of what he'd seen and treated. Stories I don't even want to post because they are just too horrible.. And he started to sob while telling me these stories and they happened over 15 years ago. Thank God for nurses and others like you. It's not an easy job, but somebody needs to care for this children and look out for them. You are truly a blessing to the profession. I haven't done bedside nursing in over 12 years (I do prior auth) and I've really been feeling some kind of way lately about the profession I've chosen. But reading this, this changed me just now. This made me see why I chose this profession and has actually made me wonder if I am in the wrong specialty. Again, thank you so much for all that you do.

Hello. I know you posted this a while ago, but perhaps still helpful for you or others. I do UR for BCBS but not Anthem. Most UR/prior auth positions are telephonic reviews. Easy work if you are able to understand insurance. Some people get it, others simply don't. Most work from home. When I do go into the office it's like a ghost town. However, at least in my company, you usually have to work for about a year before they will allow you to work from home. This is obviously because of training. And even after training, you'll still have issues/questions until you are completely comfortable. There have been some who started working from home in less than a year. Good luck!

Good luck! I just took my exam in early December and passed. The good thing is you don't have to wait for your results, you find out right after you take the exam. I am generally a good multiple choice test taker and find most exams easy, but this was a little difficult for me. Most likely because I mostly do prior auth which is way different than other areas of case management. I'm sure you'll do fine as long as you study the book and take the test questions. ETA: The exam seemed to have a lot of questions pertaining to rehab.

I do not recommend that company. They've had a change in CEO and let go of many very talented people. The company has lost its soul. Their focus is now on money and not so much on the good of the members and community they serve. I didn't work there, but lets just say someone I am really close to has, as well as others I know. I'd look elsewhere.

It really depends. It's difficult to answer because there are so many variables. Experience in the particular area you are being hired for, insurance company or otherwise, etc. Whenever I was asked to enter desired salary when applying for a position I always put "negotiable". I work in Prior Auth, I am an RN, I do not have my BSN (but I'm currently in the RN-BSN program), I work from home and I make $90,000. For the most part, you will not get paid more for BSN, just like I will not get a raise or be put in a higher range when we get our annual raise. I also have my CCM certification. No raise with that, either.

If you are following a script/process flow and not making clinical determinations on your own then you are perfectly ok and practicing within your scope of license. Where I work we have staff who are not licensed clinicians approving certain requests. However, they must follow a specific script for that specific request in order to do so. The script goes through many levels to be approved for use. I wouldn't worry about what you are doing. However, you mention that you "consult" with a nurse before making a decision. Is this in writing? Does this nurse document that he/she reviewed and approved your review? If the answer to that is no, and you do not have something in writing allowing you to do whatever it is you're doing, then beware. The RN could easily say she never reviewed your assessment and signed off on it. The same rule applies to case management as it does for patient care - if it isn't documented, it wasn't done. Always CYA. I even save emails which provided me instruction to do something that isn't usual practice. This way, if someone ever questions why I did what I did, I can produce the email.

Yikes. There are no other nurses to share the burden? We have on call nurses but it is only after hours and on weekends and it is voluntary. If just your responsibility to take call 24/7 I would NOT take job. Clarification definitely needed.