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interview help

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Specializes in neuro/ortho med surge 4.

Hi all,

I am interviewing this coming Tuesday for a Prior Auth nurse position. I really hope to get this job as I am burned out on floor nursing. Has anyone interviewed for a prior authorization nurse position and if so do you have any tips or any good questions that I could ask the interviewer at the end of the interview?

Thank you,

Heather

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 9 years experience.

I did this job before I became an RN. So the first question that comes to mind is - why does this job require a licensed nurse?

Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU. Has 9 years experience.

Will you be doing peer reviews for an insurance company?

Meriwhen, ASN, BSN, RN

Specializes in Psych ICU, addictions.

I did this job before I became an RN. So the first question that comes to mind is - why does this job require a licensed nurse?

It doesn't. But a lot of facilities like to have licensed nurses do it, probably because they can argue the justification for medical treatment better (more knowledge of the conditions, medications, treatments, etc.).

I've done UR too...it's not my cup of tea. I'm on the west coast and most insurance companies are on the east coast, so I spent a lot of time leaving messages on voicemail instead of talking with humans. On the brighter side, I learned how to present a through review in under 3 minutes, since that was the max that most of the voicemailboxes gave me :)

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 10 years experience.

Will the position require you to be licensed in other states and will the employer help with that? Good luck!

I was the Pharmacy Prior Auth Nurse for a major insurance company and we have always used licensed nurses. Non-licensed staff usual review for items less than $1000.00.

You should be familiar with McKesson/Interqual or some type of computer based medical criteria program that supports their request for services. Interqual or WebQI are two of the more common ones. You should have great assessment skills and the ability to summarize what is going on with the patient by the providers submitted documentation using something like SBAR-Situation, Background, Assessment, Response. You should be able to do at least 4 reviews an hour so 15 mins per request.

Some questions I would ask are how many reviews are expected of me daily? Or: How would you handle a situation for a provider who requests we approve an investigation medication after they have gone through the appeal process and it continued to be denied? And lastly; Are there any under individual considerations your in house providers would make for a provider request and could you give me an example of this?

Edited by Neats
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