Health Plan Insurers

A time of change

Health care reform has dramatically changed the structure of the healthcare system, including the relationship of the patient to health plan insurers.

In 2006, the State of Massachusetts passed a health care reform law that required all state residents to hold health insurance or pay a tax penalty.  Currently, over 98 percent of the state’s population possess health insurance. The new state law also created a new type of health insurer for qualified elders called Senior Care Options.  SCOs integrate health care and social support services together.

A new approach to care

Residents can take advantage of either private or public insurance plans.  The way all health insurers are approaching care is changing and will continue to do so as Accountable Care Organizations are created.  Both providers and insurers are finding that they can decrease costs and increase the quality of care by better managing patients’ care. This means a focus on preventative and primary care, and high levels of coordination between care providers.

Career opportunities with health plan insurers

To coordinate patient care and meet the healthcare needs of different types of people, health plan insurers are developing new innovative models of care.

Health Plan insurers like Senior Care Option (SCO) use interdisciplinary teams to manage the care of qualified elders.  These teams often include:

• Nurse Practitioners
• (RNs)
• Community Health Workers
• Medical Assistants
• Licensed Practical Nurses (LPNs)
• Care Coordinators

Traditional insurance companies offer different types of career opportunities including:

• Registered Nurses as Case Managers:  Nurses involved in case management use their knowledge of health care options and providers to meet a patients’ needs in a medically sound and cost-effective way. Nurses interested in this career option can take advantage of a variety of case management certification programs.
• Social Workers:  Social workers can function as care and case managers, as well as care planners, and usually oversee the care and cases for patients with behavioral health problems. Similar to registered nurses, social workers help make sure that patients receive care in a medically sound and cost-effective way. Most care manager positions require active licensure, but positions and requirements vary widely.
• Pharmacy: Insurance companies now offer mail order prescription services to their customers. This provides career opportunities for pharmacists and pharmacy support staff, including technicians, operations support, and systems management.