Telephonic Case Management

Specialties Case Management

Published

Hi! I'm interested in Telephonic Case Management. Is there anyone here who is doing this type of position? Do hospitals hire this type of position? :redpinkheThanks!

Specializes in Med Surg, Case Management, OR.

All big name insurance companies have Case Management nurses. It does help to have a broad spectrum of experience, and also home care, as you can better understand what patients may be going back home to and anticipate their needs better. I really enjoy building relationships with the patients I care for, and am starting to find telephonic case management not as fufilling. It's not to say I'm bored, I am busy all day. But sometimes I feel like a salesman, calling people who have just returned home from the hospital to get them into case management. It's also all about a numbers game. Insurance companies require quotas, or a goal of however many cases are opened to case management each month. Your livelihood depends on this. Sometimes you get caught up in quantity vs. quality. I'm a huge patient advocate, but sometimes I feel that I'm pushing myself onto these patients so I can meet my quota. But I left home care because I was burned out on the feeling of being constantly behind in charting, doing work outside of work!! So I'm in a little dilemma myself! :uhoh3:

Up Vote Up Vote ×
Specializes in Med Surg, Tele, PH, CM.
It may sound good now, but telephone only case management is BORING. Beware being bored, as a nurse you will find that is only nice for about a year. I know, I spent 2 years at Blue Cross on the phones. It is way better to do home visits.

I worked for two years for a MCO that administered healthcare to Medicaid patients. I loved it, and it was anything but BORING. Because we covered most of the state (Maryland), I dealt with both urban and rural patients and coordinated care with some of the best hospitals in the country. I only left because we moved. I now work for the state in which I live in the same capacity, and make home visits to my patients in a 5 county area in a rural setting. Give me the telephone anyday........

Up Vote Up Vote ×
Specializes in Cardiac, PCU, Ambulatory, Hospice, CM.

@ BW853: I am case manager for Aetna and get paid more than any hospital or clinical job I ever had. The turnover is low because of the high job satisfaction but that may be just with Aetna since I am hearing that BCBS is not such a good place to work. The case load is 55 - 60 pts and majority of all nurses and executive positions have home based offices. I love it and was ready to leave bedside nursing... it is so physically taxing. I feel like a professional and I'm treated that way without the gossip, politics, and back stabbing that I once felt working at hospitals ... sad but true. Some of my peers from the hospital are looking to switch over to case management as well. United Health care is another home based promoting company. Good luck to all.

Up Vote Up Vote ×
I was at Blue Cross also. Worse job ever!

Why do you say that? I've been offered an utilization review job at an insurance company. Trying to find out what its all about....

Up Vote Up Vote ×
Specializes in PACU, ICU, OR.

@ jaqs96- I have been looking into jobs with Aetna. What exactly do you do in case management there? Do you know anything about the other areas such as health coaching or UM? How was the orientation for your position? I have 5.5 years of in hospital experience in various settings. I would love to get out of inpatient care one of these days and do something with prevention and health maintenance instead. I see that Aetna pays well. I have wondered what it is like to work there, just don't know anyone personally who works there to ask! Thanks for any info you could give me:)

Up Vote Up Vote ×
Specializes in Cardiac, PCU, Ambulatory, Hospice, CM.

Hi tdncRN,

I have only been with Aetna for a short time but have read from others that have worked there that they also thought it was a great company... which is one of the reasons why I joined them. Like you, I worked in various settings, in fact, I still stay prn for PACU... I guess I am a little nervous of completely leaving bedside nursing... I am liking case management more and more each day. I deal a lot with complex medical cases and disease management... it really is like prevention, maintenance, and health promotion. Many patients/members enjoy the contact from a nurse since it's a free benefit to them to speak with a health professional. Aetna has most of their nurses work from home so if you don't want a home office, you may want to look into another company. And speaking of another company... The demand for case managers/disease managers are on the rise. I see positions posted more and more for these type of wellness coaching... which is what I enjoy doing. As for Utilization Review Nurses... they don't have much contact with members/patients. They most work on discharge planning with the hospital or facilities... not my cup of tea. Make sure you stay close to or below 70 cases... I started with 50 case which is great and unheard of but I'm moving up in numbers but Aetna is striving for high employee satisfaction so they are trying to keep us happy whenever possible. I had 3 mos of orientation which was excellent. Overall, Aetna is a great place to work but health benefits could be better but I guess the great pay helps make up for it. Hope this helps. Feel free to send more questions to me.

Up Vote Up Vote ×

Hi jaqs,

I love you post about CM. I was wondering if u can give me more info about AETNA, benefits and your experiences in landing your job. I've been trying to get out of bedside nursing, I realized I'm not happy and office setting is home for me. Im scared to jump into trying to get a job as a UR nurse for companies such as wellpoint and blue cross. I hear so many negatives things about these companies. So far united, cigna and aetna has been fair. Any info would greatly be appreciated, thanks a bunch.

Up Vote Up Vote ×
Specializes in Cardiac, PCU, Ambulatory, Hospice, CM.

Hi MissRNurse,

I am happy to answer questions... When I started nursing school, during rotations, I realized I enjoyed nursing positions that gave me independence and autonomy. When I started working in a hospital setting, I enjoyed the patient interaction but not the surroundings. Maybe that's why I enjoyed PACU so much more than med/surg type units because of that autonomy 1:1 with the pt. I picked up a PRN home health/hospice position and then after a few months, turned my home health to a full time case management and hospital position to prn. After a year of being a "road warrior" and working part home office, I was ready to move on to case mgmt in the office. I researched several different companies and notice many of them were actively hiring RNs. Aetna, Wellpointe, Cigna, and United are the big boys. Wellpointe is not located in my area but I actually hear good things about the others. Aetna is good to work for, including the pay but the benefits are not so great. I will post a link to their latest health benefits which are posted to the public on their website. I think having any type of exposure to case mgmt will help but others have been hired w/o that background. Insurance companies just want to make sure you understand the big difference in working bedside nursing vs. office setting. It's rare but a few RNs turn around and go back to bedside nursing. But majority will tell you that they will never leave the comfort of their home office or business office setting. Make sure you do your research on the company and it's position so if you get that interview, they will know what your getting yourself into. Look out for high case loads and micromanagers. It's ok to ask what management style do they use... I did. OK this is getting long. I believe your chances are good since there is an increase in these positions. Similar positions: RN Wellness coach, Disease Managers, Case Managers, Patient Care Coordinators.

Good luck!

Up Vote Up Vote ×
Specializes in Cardiac, PCU, Ambulatory, Hospice, CM.

Oops forgot to post link to benefits:

http://www.aetna.com/about-aetna-insurance/aetna-careers/benefits/index.html

Up Vote Up Vote ×
Specializes in Maternity.

Hi jaqs96!

I, myself, am looking into telephonic case management, however, I just don't know where to begin. Also, I have been a nurse for only 3 years with mainly behavioral health background. Can I do case management without the med-surg, etc. experience? I also have an MS in nursing and hope that would be a plus for me. How is the pay with Aetna? Working from home sounds ideal, but is it really? Any info would be helpful right now as I am seriously contemplating leaving bedside nursing with the little experience I have.

Up Vote Up Vote ×

I've been an RN for 14 years with critical care, ICU, and ER experience. I also have a BSN, and have been working toward my MSN. I've been applying fore case management/utilization review positions in the southwest, and no one will hire me because i lack case management experience. Good luck with trying to break into the scene with 5 years experience.

Up Vote Up Vote ×

Thank you soo much jaqs for ur responses! They've been very helpful! I wish you the best at your new specialty:)

Up Vote Up Vote ×
+ Add a Comment