Thinking about Case Management for an Insurance company

[magortonRN]

I am considering a job as a Field Based RN Case Manager working 20% home 80% field, and managing patients with Medicare for an Insurance Company. I would be using the hospital in which I would be resigning from, they are starting a collaboration between the insurance company and the hospital to improve patient outcomes. I am wondering if there are CM's out there working for an insurance company what is it like? I have been a nurse for 5 years, any where from Renal Dialysis, to ICU, step down and recently as an Assistant Nurse Manager. Do you feel secure in your job working for an insurance company? If patient outcomes are not satisfactory do you or are you threatened to lose your job??? Thanks for any input

[cubrnjvm, MSN, RN]

I am considering a job as a Field Based RN Case Manager working 20% home 80% field and managing patients with Medicare for an Insurance Company. I would be using the hospital in which I would be resigning from, they are starting a collaboration between the insurance company and the hospital to improve patient outcomes. I am wondering if there are CM's out there working for an insurance company what is it like? I have been a nurse for 5 years, any where from Renal Dialysis, to ICU, step down and recently as an Assistant Nurse Manager. Do you feel secure in your job working for an insurance company? If patient outcomes are not satisfactory do you or are you threatened to lose your job??? Thanks for any input[/quote']

I would like to see what other people say, I'm too deciding if joining that field...

[mtngrl, ASN, RN]

I work for an insurance company but it's a Medicaid program not Medicare. I coordinate long term care services and have been doing this for several years. It is nice to work from home and set my own schedule. Caseloads can get high sometimes but when that happens I just remind myself where else can I do laundry on my break lol.

[nurseprnRN, BSN, RN]

I worked as a case manager for a big medical practice with an integrated risk agreement with a big HMO for their senior care / Medicare supplemental product. I was in the hospital seeing all their inpatients, and followed them through acute rehab/SNF/home care/outpatient care, so I saw all those too. Great job, left it for a better one.

Also worked for a worker's comp insurance provider (comp is health insurance too) as a field case manager, and had a caseload of 20-40 folks in various stages of recovery from mostly ortho and neuro injury (but pretty much everything else except peds and pregnancy). Out and about, working with employers for return to work options, helping physicians understand work situations and ergonomics, seeing all sorts of physicians and therapists in all disciplines. Did this for 5 years, learned a ton. Left it for an independent CM for catastrophics job.

I never felt at risk for losing the job; if you are remotely able to keep patient outcomes acceptable you're fine. Most comp patients really did get hurt, really do want to get better, really do get better, and really do go back to work, so if you can figure out the best ways to streamline their care (and there are many), you'll have no worries. With the HMO thing, our major challenges were getting people the care they needed while remaining within the terms of their insurance coverage. Since it was pretty hard to go outside their rules, it wasn't too hard to stay within them, and our outcomes were optimal anyway.

The only CM for an insurance company I ever knew that got actually fired (except for downsizing in an company that was beginning to fail) was someone who had had an old brain injury and she just couldn't keep up with the work. We felt awful about it but her executive function was just not up to the task. There's a lot of keeping multiple balls in the air all the time and the expectation is that you will do that without a lot of hand-holding after you get your feet under you, and she just couldn't do that.