There is buzz all around that Commercial and National acct nurses are about to have RIF. Our pools are down. Faces are down. I know they don't need all of us, but this quiet before the storm is brutal. There are only case management positions open, no UM.
Anybody hear anything ?
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If Elevance’s contract to the business, state, organization doesn’t stipulate that UM and/or CM employees need to reside in the state or country that the members live, then expect the job to be offshore. It’s true, AI will replace a lot of the medical reviews. Reviews that are flagged by AI will need additional review by the nurses that are still left or the plethora of MD reviewers that are highly paid for their job.
well listening to call done by a CM in the Philippines will clearly go well with an external audit or wait...certain parts of our fine country who only want to talk to "Americans that speak American" - don't like the comment - hear this everyday with call review with members speaking to French sounding CM's, etc. Some accounts also have contracts that prevent offshoring CM - might want to look at UM or Med Review - they talk to no one and can work 24/7 and probably should be.
6/26
Makes no sense to offshore CM to the Philippines. The nurses have no CM experience, they have no idea of the challenges a patient may have here or how to navigate or find resources for a patient. They won’t be sharing any of those stories of how so and so helped a member at Town Hall that’s for sure. This place has gone downhill ever since they made Gail CEO…she really needs to go!
It doesn’t matter if you do more or less in UM. UM is going to get replaced by AI. The nurses in the Philippines will get it done if the company need a human reviewer. Turn around time will be met, probably a lot quicker, especially on the weekend and no monetary sanctions for being late. Instead of being worried about who does what, start thinking about how you can outsmart AI to keep your job.
@kz you are sorely misinformed (ill also say you sound like you are jealous???). I do UR. I have set hours and have NEVER been able to sign off when my work is “complete”. It’s never complete. There are always faxes rolling in. I would say that we are micromanaged most of the time. Whoever you are speaking about, it must be a certain team? It sure as heck isn’t mine.
why do you need UM - almost all of it can be automated - reduce the precert list and you can cut up to 75% - they are the most undermanaged staff, get to start work whenever they want - hit their quota and call it a day since they RARELY have to talk to anyone. It's a cake walk with the lowest metrics - beat up on Case Management as always. They are treated like servants who can't be trusted, lazy and stupid - its toxic all right.
Instead of RIF nurses, how about all those useless health services directors? Has anyone seen how many we have? Some don’t even know what they’re supposed to support. We need more frontline people that know what they’re doing than all these supposedly “leaders.”
If you are a nurse your time is 6/26. Right after your happy nurses week accolades by leadership. Stop working for this dump today because you won’t be here in July.
I do believe they are in the process of shifting all case management to centralized suites under Carelon with RIFs pretty much guaranteed. Constant scrutiny of our workflows, metrics, and performance. Some of our programs have already been zapped as well as some already RIFed in my dept. Direct management is constantly making comments that its obvious by reading between the lines that our dept will be eliminated with very few being offered the opportunity to shift to centralized programs, while also encouraging us to step up to the max to prove our individual value. Im over it.
They are trying to standardize CM to across the state to eventually move the work offshore. UM will be more AI driven and automated to meet turn around time and reduce “bias.” There will be a few leaders and individual contributors to manage state requirements. Be thankful if you have contract language require that staff to live within the state where they manage their members. Otherwise start counting down the days of when you will be replaced.
Nurses will be an ongoing target and as the Philippines changes how to provide education and training nurses more and more will be off shored.
The Phillipines are almost all completely on T1 networks to handle more offshore assistance
Case management is now offshore to the Philippines. What a shame on this company