Where Have All the Nurses Gone?

By Sheri Pullen

IDAM Best Practices Product Manager
FINEOS

By Christy Traupe

Product Manager
FINEOS

In the integrated absence management (IAM) world, employers often rely on carriers and third-party administrators (TPAs) to help implement their preferred operating models. Many of those models share a common goal: a streamlined, efficient process that drives optimal outcomes for both employers and employees. Historically, some carriers and TPAs staffed operations centers with nurse case managers for clinical insight when reviewing a claimant’s medical information; some employers had in-house units similarly staffed.

However, in recent years, we are seeing fewer nurses managing disability and leave cases. Instead, many carriers, TPAs, and employers have transitioned to a clinical escalation or clinical consultation model in which non-clinical case managers handle the majority of claims and nurses are pulled into only the more complex cases.¹ The biggest driver of this move may be cost reduction. Assigning a nurse to each and every disability claim drives up operating overhead and is not the lean model many employers are looking for.

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