Working Nurse

WORKING NURSE:  What is your nursing specialty?  

JUDITH A . MILLER, RN, BSN: I am a prior authorization nurse in the finance department of Hospice of the Valley in Phoenix, Arizona.  
 
What attracted you to this specialty?
I spent many years working in the hospital setting as a staff nurse and in management positions. I was determined to work with hospice patients before I retired completely, so I originally worked in case management with Hospice of the Valley for two years. I left that position for a brief period to work for an insurance company reviewing workers’ comp claims, but my heart was still with hospice.
    When the insurance company reorganized, I was fortunate to be able to step into my current position at Hospice of the Valley. The combination of a strong medical/surgical background, hospice case management experience and insurance background has provided me with a strong foundation for my current position.

How long have you worked for this organization, and how did you choose to begin working there?
I have worked for Hospice of the Valley in my present position for nine years. I strongly support the hospice philosophy for end-of-life care and feel that Hospice of the Valley is the best choice in the area to provide such care.

How would you describe the hospice philosophy for end-of-life care?
Hospice care provides a team of healthcare professionals to serve people with life-limiting illnesses and their families. Most patients are cared for in their own homes. The hospice team supports the patient's primary caregiver — a family member or friend — offering a compassionate presence during this meaningful time. Team members work together to meet the medical, emotional and spiritual needs of patients and families. The goal is to enable people to live as fully and comfortably as possible.

What does a typical day involve for you?
My typical day consists of reviewing all referrals coming to the agency for hospice services. I follow patients who have commercial, Medicaid and long-term care insurance with carriers that require authorizations and concurrent reviews. I also provide education to the staff about specific services the agency might be responsible for related to insurance benefits and contracts. I frequently communicate with outside vendors about billing questions related to hospice patients, as well as with staff, patients and families about services offered by the agency.
 
What are your favorite aspects of the job?
I enjoy the challenge and opportunity to educate insurance company personnel regarding the benefits of hospice for their clients, as well as keeping up with the nearly 3,000 patients who are cared for each day by Hospice of the Valley and relieving any anxiety they might have about the financial aspect of hospice care.

Any challenges or least favorite aspects?
Long waits on “hold” while waiting for someone to talk to at insurance companies is always a challenge, as is speaking with insurance company personnel who do not understand the advantages of hospice services for terminally ill patients. Some insurance benefits for hospice services are limited to days or specific dollar amounts. It is challenging to find creative ways to utilize other benefits covered under the insurance plans to cover ongoing hospice services.

Tell us about a time you had to arrange a creative solution to a financial problem.
On rare occasions, patients’ insurance plans do not have a benefit for hospice care. In these cases, I work with insurance companies to show them the cost effectiveness of hospice care compared to inpatient hospitalization and the psychological and emotional benefits of keeping patients out of the hospital and in their homes. Many times we have been successful in converting home health benefits or another existing benefit in the patient’s insurance policy to cover hospice services.
 
Do you miss being at the bedside?
Being an “old-fashioned” nurse, I would have to say I do miss the one-on-one interaction with patients and families, but I find what I do now rewarding in a different way. I feel I help reduce the anxiety of our patients by assisting them with insurance issues.

What advice would you give to a nurse looking to enter your field of nursing?
This position is far removed from hands-on nursing care, but having a strong background in that aspect gives one a good grounding for the position. Having strong organization, prioritization and telephone skills are helpful, plus being able to multi-task while on hold is a definite plus! 

FURTHER REFERENCE:

Financial Management for Nurse Managers and Executives, by Steven A. Finkler, Christine T. Kouner and Cheryl Jones
Health Care Financial Management for Nurse Managers, by Janne Dunham-Taylor
Online RN Nursing Programs (www.college-net.com)
 

1 COMMENTS

• Susan S.

  Thanks for the informative article. This shows what a great "base" nursing is, allowing us to move into other specialties when we are no longer able (or interested in) doing bedside. There are so many options, and working in the finance dept wasn't something I'd considered before.

  Nov 13, 2008