HCMs, get ready to do SS and CHE work. It's coming very soon! Why pay all these different roles when they can have the nurses do it while they call members daily! HCMs will become a one stop shop. You may have to work 18 hour days, but you're salaried so it's OK. You will also absorb all the PHC rosters when we are all laid off. That's why they are hiring more nurses. I am pretty sure this is the direction of HAH!
Perfectly put, @Olfx94t-srh.
I was on high BP meds during my time in Humana. Once I quit, I am no longer on the meds. Humana was killing me little by little. Leave before it's too late!
I was on a team that was about competing, and numbers..... It was stressful to the point my BP was high, then my manager was layed off and i moved to an amazing leader.....my BP and stress is down...,my numbers are still awesome!!!! If those in charge would have better inderstanding of peoples styles maybe theyd understand some employees do better having more hands off management and pressure
The coaches who are turning everything into a competition are making a mockery of what we are trying to do as professionals. The COMS who are creating an environment in which coaches are shamed for being "beat" by other teams need to go. This is not care management. This is a joke. In the midst of all this, the members' actual needs are forgotten.
HCM RNs in HCCP do a lot more for their members than what poster about case management realizes. We have to get at least 44 calls per week and spend an average of 60 minutes on a typical post discharge contact. All GAPS in care have to be addressed and if we end up making 10 support calls in one day, it does not count as successful contacts. We assist members with tier reductions, referrals, and educate about grievance and appeals, along with education about health diagnosis. Surveys have to be completed at 100% or we will get in trouble during audits. We are on an all time high of UTCs because of RIT returns that never pick up again, members who refused program but were never taken out of the program. Don't criticize what you don't know.
Hcm ss here....nurses, I knew you had crazy numbers and surveys, but all that other stuff, your roster size, changing rules and your coaches encouraged competition???!?!
I was told reimbursement was like the split end score on the nursing home MDS. Reimbursement is based on survey scores and the time spent on the phone, like 2 29 minute calls per month per member.
I tried looking for CMS requirements but am having trouble finding specifics for telephonic care management.
Also, is Humana reimbursed for surveys? Earlier this week, we were told we need to "beat the other teams' percentages of completed HEDIS surveys." But to get to 100%, there are questions that nobody knows the answer to, like dates and locations of particular screenings.
My coworker asked about this during our meeting and our coach said to "just fill those parts in" if the members don't know. Is that not fraud? I'm supposed to be making up dates and locations for screenings just so the survey is at 100%? How does that even help the member?
I just won't do it.
The other day, we were in a mad race to "beat the other teams' IVR percentages," now apparently that is no longer a priority and 100% on HEDIS is now an emergency, regardless of whether the members can answer or if we have to just fill in the blanks.
I can't imagine this is what CMS means by care management?
How much more can they pile on us.mist of us Feel physically and emotionally ill everyday after work from the constant stress to get metrics in. They have made it impossible to do this in a normal workday. documentation is insane the care plans for HCM's are growing and growing your handed care plans from people that have done them completely wrong and then you have to fix them then you're expected to do Ethics training as well as all the other learning opportunity CBT's during your workday . Now we have to do pharmacy reconciliations and tasks for every post discharge as well as the new HRA for the post discharges. There's no time for anything and you can't even let the members speak or you won't get on done your surveys it. is a horrible feeling Plus the fact that we went to school to be nurses and now spending our days dialing and getting UTC after UTC because these members are sick of the surveys and the constant questions so they are not answering our calls I miss the days that I was able to really listen to our members and help them. It's just going to get worse and worse. Believe me I am looking and so is everybody else
Totally my opinion: I feel like it's not CMS rules or changes, it's leadership's misinterpretation of CMS rules, issues with licensure vs. Non licensure, the role of nursing, social work and PIC and their lack of clarity on who should be doing what. MF is an engineer by training , I believe. How in the world would people without medical training know how best to utilize nursing and social work dollars? There is a role for everyone, collaboratively, and that is what CMS wants. INTERDISCIPLINARY. but that's a concept Humana doesn't get.
This is in regard to RN case management before Humana at home it was Humana Cares and before that it was Green ribbon health. Rns did not have to send anything since rn actually had tine to fully educate guide ,refer (numerous support calls) acutually follow up on main member issues and next call determined by nursing judgement. Rn CONSULTED WITH SW regularly but there were a lot less members and it was not dictated on how many calls to make per day ,or repeated assessments and non user friendly careplans, and ever changing confusing process changes
There has been no CMS change stating that everyone has to be licensed in this line of work. You can easily go to their website and look up needed credentials.
I think it's the multiple rounds of layoffs this year that have shipped the masses into a frenzy, and justifiably so. This site is just a water cooler for folks living in the virtual WAH world.
For us PHC's, we are already stressed, whether we visit this site or not. I think we all know enough to weigh what we are reading on an anonymous site with what is actually happening at work. Unfortunately, what is actually happening, at least this year, hasn't been good (for us in the PHC role, at least).
Social workers are not needed to be hired, because there are more than enough to do the work and the warm transfers, there is no need to hire more social workers at this time. The hires go along with the pillars that Humana said they wanted to do
Please point out the many, many rumors that have come true. Back up your statement with facts please
Well, but many many rumors have proven to be true in this website, so...
Ever notice that people drop these bits of info but never back them up or pink to solid facts. You could say anything in here to ship the masses into a frenzy!
Humana is a bad, disorganized company
So if SW's are required, why aren't they hiring any lately? Just RN's are getting hired. Weird!
But what and when were these changes?
Yes RN and SW are required
Please provide a link for CMS changes, licensed social workers are part of the requirements, do you have a link to CMS with those changes?
Poster, I get that, too! Or CS says different things, or you can't understand them, or they are so rude! It would be easier if we could give benefit info off the grid, rather than wasting the time for the effort
What CMS requirements have changed? When did they change?
What CMS changes? I am not aware of this
CMS requirements have changed and that's why there is going to be a change in staff
Below should read "what should have been a simple question"
That sounds like an overgeneralization about nurses. Maybe some do that, but I spend a disproportionate chunk of every week trying to get simple answers out of CS. I literally just spent the half hour before my lunch getting a rep to answer what shouldn't have been a simple question, only to find out the rep is incorrect.
Case management is case management, for the poster who said for the nurses to get ready to do other roles....maybe your role will be case manger, not just nursing, or not just writing tasks to save yourself the time to transfer a call to CS about a members benefits and tasking a social worker to do that...I'm a CHE and was amazed when a friend of mine told me the nurses do that to social workers and CHEs to save time to move on to the next person, have another department do what you could easily do! Maybe this is why they're doing layoffs, since case managers aren't doing case management
Hcm ss are not a thing of the past, they are mandated by CMS.
Yes, SW's will soon be a thing of the past. I feel sorry for all the new Nurses... you don't know what you just signed up for. It's hell.