What Does A Nurse Case Manager Do For An Insurance Company

March 15, 2021 Post a Comment

I am a Telephonic Nurse Case Manager in Workers Compensation for a well known Insurance Company. So I recently started a nurse case manager job at an insurance company.

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RN Case Manager salaries at Aetna can range from 64776 - 92920.

What does a nurse case manager do for an insurance company. Its case management program involves trained nurse case managers offering free service and support helping members manage their benefits arrange care and find resources. For you they are supposed to facilitate coordinate and manage your care. In a hospital a nurse case manager is in charge of coordinating care plans and health services upon discharge from the hospital.

Many times there may be underlying pressure on the doctor to force an injured worker back to work too quickly or to suggest cheaper medical treatment as opposed to what a physician may truly want to do. I received a call from Blue Cross Blue Shield of MI offering me an interview for a Case Manager position with them. Through a collaboration with multiple specialties case managers ensure the patient is receiving quality medical care.

The registered nurse case manager collaborates with all professionals who provide care for patients and ensure that all available resources are considered in. Theoretically nurse case managers work independently of the insurance company. I like the position pretty well and have been at it for 2 years now.

The work comp insurance company. She is not attending your appointments to help you get better but rather for the insurance company that wants to cut off your medical care and benefits. They can work for healthcare practitioners hospitals or insurance companies.

A registered nurse case manager is a registered nurse who integrates the needs of the individual patient with medical services and insurance companies. In 2009 I chose to become an RN Case Manager RN CM for an insurance company. In addition the case manager coordinates the services of other members of the healthcare team and caregivers communicates with the health insurance company communicates with the patients physician and supervises visiting nurses and other home health aides who provide support.

Apply to Case Manager Registered Nurse Case Manager Senior Case Manager and more. The nurse educates injured workers on proper care mediates between the employer and their worker moderates the physicians care plan and negotiates with the employer and insurer to get the best care outcome while saving costs. A case manager is a specialized Registered Nurse RN that works with patients and providers to determine the specific care that is required and the best options for that care.

The role of the nurse case manager is as an agent for the insurance company not a medical provider. I am going to sit for the CCM exam this August. If you signed a form for your case that allows the Nurse Case Manager to communicate with your doctor then it is allowed.

Generally he or she must also act as an advocate for the patient with insurance companies in order to ensure home health care medical equipment and rehabilitation services are covered after discharge. This estimate is based upon 91 Aetna RN Case Manager salary reports provided by employees or estimated based upon statistical methods. The typical Aetna RN Case Manager salary is 77242.

At the moment I work as an RN case manager. Never forget that no matter how kind they are to you. Unfortunately it is not as clear what the nurse case managers job is when the insurance company uses Rule 2002 to hire a case manager.

I really wanted to make a difference from a different perspective other than at the bedside. The nurse case managers job is to keep everyone updated and on task. RN CMs help members learn more about their conditions and medications address symptoms assist with contacting the provider and provide information on general health and lifestyle factors.

Under the rule it is not clear whether the nurse case manager works directly for the insurance company or not. The role of the nurse case manager is to monitor your care and report back to the insurance adjuster. Anyway at the beginning I.

So heres the good bad and ugly on nurse case managersplus a review of your most important rights. While they do provide the insurance company with relevant information about a patients condition and medical treatment they should not advocate against the patient during settlement negotiations or otherwise perform investigative activity on the insurance companys behalf. I started off very enthused and pumped as this was a new venture for me.

This Nurse Case Manager is basically another adjuster on your case and reports to the people who pay hisher paychecks. Legally the nurse case managers primary concern is supposed to be your recovery and return to work.

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