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Discussion

What exactly is managed care?

I'm sorry for the stupid question but what is managed care, exactly? Is it referring to working with an HMO insurance company? I keep seeing this requirement pop up in some job descriptions, and I'm not positive that I can say that I have experience in managed care.

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    • Admin

    Moved to Case Management Nursing forum.

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    What are they stating in the job descriptions? Managed Care Organizations include HMOs and PPOs. I have experience with both.

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    • Author

    The positions are for a large variety of areas in nursing such as utilization review, case management, health coach etc. So it sounds like it's for nurses that have worked with health insurance companies. I coordinated with case managers in my hospital positions, to get the right services for the patients, but I wasn't the one doing all the legwork with the insurance companies and fighting them for services, so I guess it's a no for me.

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    The positions are for a large variety of areas in nursing such as utilization review, case management, health coach etc. So it sounds like it's for nurses that have worked with health insurance companies. I coordinated with case managers in my hospital positions, to get the right services for the patients, but I wasn't the one doing all the legwork with the insurance companies and fighting them for services, so I guess it's a no for me.

    The position as you have described sounds like a RN case management position. However, hopefully they have a navigator and social worker providing this RN with support. I have worked in such positions where I did the work of 3 people... I did not remain in those positions for very long and neither did anyone else that worked for those particular companies. So, you may be dodging a bullet by moving on! :)

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