August 9, 2023

When you picture a nurse, you might envision a hospital or physician’s office. But nurses also work in a clinical capacity for health plan administrators and insurers. One of Nova’s registered nurses, Lorene Barulich, wants the world to know she and her team and other nurses in the industry work hard to walk with members on their journey to better health. In this episode of our “Under the Coverage” podcast, she discusses how nurses help members overall, as well as patients who may face barriers to care, and why she what she does.  

With more than a decade of experience as a nurse in oncology settings and five years working on the administrative side of health insurance, Barulich has great perspective to share in “Your Health Plan is Calling.” When it comes to nurses at insurance organizations, Barulich says their roles typically fall into two main categories – utilization review, which is approval and coordination of services with providers, and case management, which involves working directly with members to coordinate care and resources. She discusses some of the common barriers to care her team works to address, including finances, transportation, food, and sometimes, overall safety.

“There’s so many barriers, whether you’re talking about inpatient setting, outpatient setting, or just regular everyday primary care and health and wellness,” Barulich said. “But that’s just it. It’s that side of nursing that’s not giving shots and it’s not starting IVs and it’s not changing dressings and all that stuff that people think about. But it’s the heart side and the mind side and really listening, especially on the phone, we can't even see you to assess you. So, it’s listening and hearing what’s needed. And then making it happen.”

In addition to addressing barriers to care, Barulich talks about how nurses at TPAs and insurers can provide support through the lens of a member’s benefits. Whether it’s a service, medication or medical equipment, the nurse can guide the member to providers based on costs, location, quality and other factors to help meet their needs. With this in mind, she advises people to answer their phone when their insurance company calls or to make it a point to call the insurer and ask to speak to a nurse.

To hear more insights from Barulich, check out our latest episode, “Your Health Plan is Calling.”

In 2022, Nova launched “Under the Coverage,” a podcast featuring people who spend their working days focused on health benefits and health care, to share their insider tips and information they wish every health care consumer knew.

How to Listen

New episodes – each 15 minutes or less! – are added regularly and are available on SoundCloud, Stitcher, Spotify, Apple Podcasts, Google Podcasts, Pandora, Amazon Music and TuneIn. You can also listen via digital assistants like Alexa, Google and Cortana. Just ask Alexa to, “play the Under the Coverage podcast on Apple Podcasts” (or wherever you get your podcasts).

Have an idea for a future episode or a question you’d like answered? Find Under the Coverage on Twitter @UndrTheCoverage or email podcast@novahealthcare.com.