Nursing Jobs With Insurance Companies


What Is an Insurance Nursing Job?
There are basically two kinds of nursing jobs that can work out of insurance companies, and one of these can even work from home telecommuting.  They include the RN Practitioner for Health Plan and Insurance Assessments, and the case manager for an insurance company.

In case you were wondering, you must be a registered nurse (RN) first in order to apply for either job.

How Do I Make RN? 

Once you’ve passed high school and shown your excellent math and biology/chemistry skills (and if you don’t excel in these, do NOT take up nursing), head for college to sharpen these very same attributes of yours in advanced classes.  After a year or so, sign up for a Nursing Program (you can pre-register and take preliminary classes as early as high school, by the way).

You are looking to achieve not only an RN but a BSN (Bachelor of Science in Nursing) or, better still, an MSN (Masters of Science in Nursing degree), which will make you even more attractive to the insurance company.   An MBA with a nursing background would be a gold mine for them, so if that is your bent, by all means pursue it.

Once you have completed the 4 to 6 years necessary for the MSN (and this will include up to 4,000 of supervised clinical hands-on experience), you can sit for the NCLEX-RN exam.   And of course, complete your Master’s degree in thesis and exams.

Now About Those Nursing Jobs With Insurance Companies–?

So now you’re an RN with a BSN or MSN; in other words, you can get a job in this field.  So let’s talk about the telecommuter first (be aware that, even though you work from home, you should be within driving distance of one of the insurance company’s branch offices).

The Case Manager (Critical Claim Review) Nurse

Don’t let the humble title fool you; this individual is usually listed as a Critical Claim Review Nurse.  Because she works from home, her position seldom requires a security clearance.  She will be in charge of reviewing medical claims from insurance customers with diseases, conditions, injuries or related misfortunes of a medical nature.

The Critical Claim Review Nurse is  a contract hire, who must be able to disseminate, over the phone if necessary, information about services the company offers and rates of payment.

Many of these claims will receive system-generated denials; that is not, however, the end of the case, as the CCRN must review them thoroughly in the event of a claims reconsideration (which can be requested by the patient, the agent or even the company).   She then forwards unresolved cases to field medical directors with her recommendations, completes patient reviews and forwards them to the Insurance Company’s Transactions department.

Her job, like that of many other registered nurses, shows a favorable outlook from the Bureau of Labor/Statistics. A projected 21-27% growth over the next ten years, and a salary of around $60,000 (some are paid hourly, average wages $31-$43).

The Registered Nurse Practitioner—Health Plan/Insurance Assessments

The RN for Health Plan Insurance Assessment usually must have at least 3 years medical experience in addition to the MSN, and a license in good standing.  Like the CCRN, she is a contract hire who conducts in-person health plan assessments with prospective and actual clients (whose medical conditions may have changed since purchasing the policy).   This is a traveling job, in that the RN goes to clients’ homes.

She must be able to relay all relevant health information to the company agents, as well as conduct interviews and record information at the same time (excellent typing/stenographer skills are a plus).   She must be a licensed and insured driver, with professional liability insurance, and must provide her own vehicle.

Her job is also “favorable” in outlook from the BLS, a projected 21-27% growth over the next ten years, and a salary of around $55,000 (some are paid per assessment, average wage $100-$115).

So, you’ve seen the two major Nursing Jobs with Insurance Companies.   Do they insure your career and future any better?  

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