Unsustainable Work Model

I am a telephonic nurse case manager for a medicare HMO. I have worked for over 7 years. I enjoy helping our members. Helping people is why I went into nursing. Our target population is the urban poor. It is a very interesting and challenging population to serve. Our goal is to try to help people maintain their health and avoid hospital admissions. That is a very ambitious goal. I guess like anything else we succeed with some people and we fail with others. I think we have mixed results with the majority.


One thing about my job is that it is hard to prove that you are doing anything to achieve your goals. My company has been through a lot of changes in the last 4 years. The current management is more interested in numbers than before. They want us to contact as many people as we can. We get new members all of the time. Members are always being discharged from the hospital. Here is the part that appears to be unsustainable. They want us to have no more than 50 case open at one time. That means you must be closing cases all of the time. If you have 50 cases and you get assigned 15 new case in a week you should close 15 cases. In an ideal world that is what would happen. That does not happen in the real world. You can not close someone you just opened-it does not make sense. You probably have not had a chance to do anything with the member. There are 5 case managers and we all have more than 50 cases open. We were told we were going to be more busy in the new year but this is way too busy. My boss said something about raising the limit on cases from 50 to a higher number. Like that would solve our problem. They want to hire a couple of more nurses. I do not know what is holding things up. There are a lot of unemployed nurses. A few new nurse might help for a little while.

The head of our department has a doctorate. He is very smart. He is not a nurse and he has not done telephonic case management. Since he has never done my job how does he think he can design a system that works? The system he has designed is very similar to the system we had when I first started with the company. The production requirements were less back then. There were 90 case managers and the system seemed to work. The system does not work with 5 case managers.


I want to work. I want to be busy-the time at work goes quicker if you are busy. Everyday at my job is busy. Other jobs I have had were different. Some days were less busy than others. I had the feeling that I could accomplish the work tasks assigned to me.  I did not have the feeling that I was overwhelmed with my work load. Now I feel like there is not enough time in the day to do my job. I have done some work on the weekends to keep up.  There is a lot of stress at work. Every case manager feels the same way. One of the case mangers had a mini nervous breakdown and she missed work for two days. She has a set of 6yo twin girls and she is divorced. I thought she might  not come back. Thankfully for her family and her fellow case managers, she came back.

I am going on vacation next week. I need the time to destress.


A social worker left a few months ago. Apparently he had some things to say in his exit interview. This got the attention of our management team. They called in a consultant to work with our managers. They had a few meetings with the case managers. They slowed down the number of cases we get. Things are a little more managble for now.


I was fired on Thursday 1/26/12. My company was bought by Healthsprings an insurance company from Nashville tenn. The deal became final on 12/1/10. 2011 has been a year of tremendous change. We were told to increase the number of members in our queue from 50 to 110. That is an increase of 120%. We had to get 10clinic appts every week. If we did not, then our audit scores would be decreased. After a few months the clinic appt requirement was reduced to 5 a week. Still, high paid licensed professionals calling for appointments for a clinic. Who thought of that idea?

I was "OK" Until I got back to work after my october vacation. My queue was down to 104 before I left. When I came back our weekly rounds were changed. We were divided into two groups. We had to report on our members who had high amounts of readmissions. The chief medical director of the company attended the meetings via phone. Once he came to philadelphia just to be at the meeting. We had to give updates on members we had reported on from previous meetings. It was like the spanish inquisition. What are the barriers? what is driving this person to the hospital? (why is it suddenly my responsibility to keep this person home?) My work load doubled. In the 16 weeks before my vacation, 6/16/11 until 10/18/11, I got 156 new members referred to me. In the 8 weeks after I returned I got 153.  No one could keep up with the increased work load. I was working 5 hours every saturday and a few hours on Sunday. I was under a tremendous amount of stress and my performance suffered. I was having horrible one on one sessions with Betty Alexander every week. Our relationship was poisoned. I kept on getting further and further behind. I was given a final notice on 12/20/11. Straighten up or I would be terminated. I knew that I would nor be able to fix my imperfections. I knew I was going to be fired. When I was fired it was a relief.

I was scheduled for a meeting with Betty and Audrey at 12pm. When I went to Audrey office she said we are waiting for Conne from hr. I knew I was going to be fired. Betty escorted me to the elevator. I hugged all of the case managers in my department. I left the building.

Hopefully I will get a new job soon. Until then I will be on unempolyment.


I got a new job within two weeks of being fired. I will start work on March 5th. The company is located in Worthington Ohio. I will be going for a two week training class. The job is work from home. They are going to send me a computer, an all in one printer, fax,copier and a business phone., scanner. I had to get a separate internet connection for security purposes. I estimate that the company is investing 10,000 before my first day of work. The starting pay is 58,000 approx 20,000 less than I was making. I will not have to pay the city wage tax and I will have no travel expenses. I will only be able to contribute 15,000 to my 401k. my take home should be approx the same amount. The health benefit is an HRA-health reimbursement account. There is a 1600 deductible. Luckily, I am healthy. I think this job will be less stressful.

Before I was fired I prayed to God every day to please help me have a good day. Please help me to find a new job. God answers prayers.


I am in my 4th year of working at home as a telephonic case manager. The production goal is 45 billable hours every week. It was a challenge trying to achieve that goal but finally I started doing it every week. Sometimes it is a challenge and I work until 7pm on friday but I make it. I always try for at least 46 hours and I achieve that goal. In December 2016 I will be 66 and eligible for social security. I hope to be able to work part time for this company. Three days a week, Tuesday, Wednesday and Thursday, that is my dream job.
steve824 steve824
66-70, M
Feb 10, 2010