Job Responsibilities
Coordinating & conducting on-site reviews of primary care
providers of healthcare including behaviorial health. This
included medical record reviews to assess quality. Performed
HEDIS, Communication & Clinical studies. Provided practices with
resources to implement corrective action to attain compliance
with the quality standards for the network. The Standards
consisted of NCQA, OSHA, State Board of Health & HEDIS
requirements.About 75% of my time was on this major job
function. It involved traveling to the practices in a number of
counties. I also assisted with complaint investigation & quality
flags turned up via internal systems.
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Job Requirements
Hiring requirements consisted of RN license in the state
practiced.The hiring manager indicated she was seeking
experience in doing on site & medical record reviews.
My education consisted of: 3yr nursing school, 4yr college BSN &
grad school MSN.
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Uppers
Implementing education programs, disease detection & preventative health to
actually help patients. I enjoyed building relationships with providers to
enhance the quality of patient care.
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Downers
Nurses in insurance companies are not held in high esteem. They
are assigned clerical functions by management. The deception &
lack of ethics & integrity of business people will knock your
socks off! Paying claims & preventing disease is overshadowed by
marketing stunts with extravagent spending. The internal
communication systems ie phone / voice mail & Email are setup
for members to have the least access to people to actually help
them.The lack of emphasis on the mental health connection to
physical conditions & barriers for patients to get the mental
health care they need is a problem for individual wellbeing.
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Lifestyle
The insurance company environment is one which includes a conservative dress
code including shoe inspection. Company social events consisted of an emphasis on
United Way fund raising events. Business travel was almost daily. The difficult
travel was overnights with little notice. After making arrangements for the
required travel, cancellations & reschedulings were common place without regard
for home disruption & costs. Work hours varied depending on appointments & their
locations. Some days were 12-14 hr although the job description was for 7.5 hr
day.
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Compensation
Salary exempt from overtime $49,811 plus bonus eligibility
Health, Life & Disability insurance were employer paid with
large employee contributions. No stock options. It was mandated
by the company to work from your home & make home modifications
to their requirements. After making all these expensive
modifications you were required to drive to any where in 57
counties in the state & perform work as assigned.Expense
reimbursement average turn around time was 1 mo. & advances did
NOT exist for my pay grade level.
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Advice to Jobseekers
I would advise the nurse considering working for an insurance
company to take stock of his/her values. At an insurance company
the driving force is money- NOT the difference between right &
wrong or what is best for the patient. I believe many nurses are
attracted to insurance companies from clinical settings for day
shift & no week ends. They must be aware to consider the
corporate climate.
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