My Nurse Specialty
A podcast for nurses who want to explore the many specialties and career paths within nursing.
Nursing school teaches us how to be nurses, but when it comes to careers, most of us are only introduced to a handful of specialties, often based on chance conversations or limited clinical experiences. Beyond that, we are expected to figure the rest out on our own. That is often where uncertainty about what comes next begins.
Whether you’re a nurse, nursing student, or aspiring nurse, this podcast exists to expand that awareness. In each episode, you’ll explore nursing specialties some familiar and some you may not even know exist through real stories and insight that help you better understand what may be possible for you at any stage of your career.
We talk with real nurses who share their stories, their specialties, and the paths they took to get there.
Real nurses. Real stories. Real possibilities.
My Nurse Specialty
Ep 10: Remote Nursing Jobs: What a Prior Authorization Nurse Does
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In this episode of My Nurse Specialty, I talk with Nurse Daisy about how she moved from bedside nursing into a full-time remote role as a prior authorization nurse. She shares her path from skilled nursing and emergency nursing into the insurance side of healthcare and how this work-from-home specialty became the right fit for her.
We also talk about what this role looks like day to day, what skills transfer well, what nurses should look for when applying, and the benefits and challenges of remote nursing. Daisy gives a realistic look at this specialty for nurses who want more routine, flexibility, and a non-bedside path.
In This Episode, You’ll Learn
- What a prior authorization nurse does in a remote role.
- How bedside and ER experience can help nurses move into this specialty.
- What to look for when searching for work-from-home nursing jobs.
About My Guest
Nurse Daisy is a prior authorization nurse who works full-time from home in the insurance side of healthcare. Over the course of her nursing career, she has worked in skilled nursing, emergency nursing, outpatient surgery, home health, school nursing, and private duty nursing. She has now spent more than a decade in her current role and is passionate about helping nurses explore flexible, non-bedside career options.
Connect with Nurse Daisy
Instagram: @thatnursedaisy
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Welcome to MinorScope, a podcast for nurses who want a clear view of what's possible in product. I'm Rebecca, a registered artist, a Christmas, and someone who has different. Hi, welcome to my nurse specialty. I am so excited to do this episode today because my guest, Nurse Daisy, has a specialty that everybody asks about. So it's true. Daisy, tell us your name and what your specialty is.
SPEAKER_00Hi, my name is Daisy. I'm Nurse Daisy Online. I am a prior authorization nurse. There's different titles for it for different companies. You can hear it as a referral nurse or pre-certification nurse, but essentially I work in prior authorization and I am 100% full-time at home. So I'm a work-from-home nurse.
SPEAKER_01That's so exciting. A lot of nurses want to get to that work from home job. And like, where did you start in your nursing career?
SPEAKER_00Oh my. I will be a nurse for 19 years in July of this year. I started in 2007. I was an LVN, a licensed vocational nurse, LPN, if you're not in California. I started off in a SNF school nursing facility. And it was the hardest job I've ever had. And I did that for about two years. And then, you know, my mom and dad encouraged me to go for my RN. And I was like, all right, well, let's just keep going. So I went for my RN, finished, and I had a hard time finding a job for a minute. And I went back to the SNF, but as a supervisor. So the workload was a little bit better, but still a lot to delegate, a lot to manage. And I just kept searching for another job. Let's just be real. And I finally landed a position in the ED. So from that point, I worked in the ED. I dabbled in different specialties. I think I just really wanted to find out what else was out there. So I did outpatient surgery, I've done home health, I've done school nursing, I've done private duty nursing, but I've always had like my background as the ED. So just to have that in my resume and my experience. And one day I was searching for another job on Indeed. And I saw something that just like really stood out to me. And it was like RN non-hospital. I'm like, wait, what? Non-hospital? What is this? And just that story. I wasn't always work from home. We worked in an office setting when I first started. So when I saw that opening, it was like non-hospital. So I just kind of like applied right away and got a call back from a recruiter and just said, Hey, do you have your RN license? Said yes. What's your background? And gave her my resume. And she's like, Oh, you have ED experience? The company wants to hire you. So mind you, it was kind of a temp agency at first. So that's kind of how I got my foot in the door in this non-bedside career. And yeah, I got hired at this company that's an insurance company. So I managed Medical and I worked in the office for from 2015 to 2019. And 19, I went remote, and I've been there ever since. So I am going to 11 years at the same company. So I've been in my position for 11 years. So that's kind of the story.
SPEAKER_01Yeah. So you that that's I'm glad you shared that because nurses are trying to get over here. And temp agencies are sometimes the way to get your foot in the door of getting your experience.
SPEAKER_00Yeah. Yeah.
SPEAKER_01So yeah. Once you started, did you have to like get some extra certifications when you started?
SPEAKER_00No, not at all. So I learned everything on the job. So once I got hired through the temp agency, and mind you, I just thought it was really going to be temporary. They didn't say, hey, this is how long your job is. And I didn't really care too much because I still had my, you know, my backup job at the ED. So I was like, all right, you know, let's just see how this goes. And you know, six months into it, they're like, well, you know what? We would like to hire you full time. I'm like, okay. So um everything I learned was during my orientation. It was a very long orientation. I mean, I guess it was kind of long, maybe like maybe two months. But it was a brand new world for me. Like computers and you know, navigating different like systems and where you find the charts and how you document and all these different like processes of how to review cases. So I learned everything when I got hired. I did not have any extra certifications or skills. I mean, I literally just gave them my resume. And it was just my nursing background, my my inpatient, my bedside. That's all the experience I had. So that was like the resume I had. And I think what stood out to them was that I had some ER experience. And when you do what we do, you obviously don't see a patient. You just have to like read the chart notes and you have to like critically think like, okay, what am I seeing on paper doesn't match what's medically necessary for us to, you know, review this case and whatnot. So everything I learned was on the job, and I'd say it was a big learning curve from going from bedside to desk side. It was about probably two months of orientation, and I learned everything on the job.
SPEAKER_01Okay. So and you would you say now this is suited to how what nursing is that you love what you're doing?
SPEAKER_00Oh, I love it. I I mean, I've been here for 11 years and I've not switched positions. I've not wanted to move up or move into another department. I can generally say I love what I do. And I think it also helps when you have really good supportive management. So I'm very lucky to say that. And yeah, I don't plan on going anywhere.
SPEAKER_01That's important, you know, support from management in any job. So that is definitely good to have there. Now let's go through like a day. Like, what is it you actually do? Because when I talk to a nurse and they say, I want to work from home, I'm like, you know, and what is it from home that you want to do? Because there is a lot of work from home jobs for nurses. Um, so you're on the insurance side, you said.
SPEAKER_00I am on the insurance side. And on my end, I do prior authorization. So anything that a patient would need, you know, it could be an MRI, a surgery, it could be DME equipment. We don't do medication, we have a pharmacy department for that. But I mean anything you can think of, you know, if you needed to go for an MRI of your back, you know, you go to your PCP, they say, hey, okay, you need this done. That office sends it to the insurance company. And pretty much every day I log in, and I have like a little like a box, like a queue that I see all my cases. And I'm pretty much going through each case, reading the chart notes, you know, making sure there's doctors' orders, making sure there's like enough critical, I'm sorry, clinical documents. I I need to review it. And we have these guidelines that we have to review against and policies that we need to follow. And I'm basically reading chart notes and you know, sending it to the doctors that we have on with our company and collaborating with other nurses if I need to. But basically just I'm reviewing. I I'm a chart reviewer basically, and essentially that's what I do every day, all day. But there's different ways to review, also.
SPEAKER_01So yeah, pretty much reviewing.
SPEAKER_00Okay, and and and then you said the title of what you do is called So in my company, they call it referral nurse because we review referrals, referral for MRI, referral for surgery, but essentially we're prior authorization nurses. So if you go to another state, I mean they're all kind of like interchangeable referral nurse, prior authorization nurse, pre-certification nurse. Essentially, it's under utilization management. When you work for like a company that does insurance or even hospitals, they have a utilization management team. And so that's the umbrella where my my job description would be under.
SPEAKER_01Okay. And that's like a referral nurse. And I like how you said the different titles because you can find them under different titles when you're looking for a job.
SPEAKER_00Mm-hmm. Mm-hmm. Exactly. Because California and Texas may have different titles for these positions, but essentially that is what we do. We're reviewing cases, we're reviewing for medical necessity. And a lot of times, you know, prior authorization is like an umbrella word or an umbrella phrase for what I do.
SPEAKER_01Okay. And now that you've been there 11 years and you've seen new people kind of being brought on board, or um, what are they asking for now for any certifications ahead of time or training? Or do they just like around? It sounded like you were a well-rounded nurse. And that's why they said, okay, we we think she'll be good. We'll we'll hire her. Um, you know, with the experience that you had.
SPEAKER_00I think definitely my ER experience really helped me in pretty much any job application I've ever applied to. ER has always been, you know, something that stood out. When I think about the new hires that we have had, they've had a lot of ICU experience, CCU, ED, um, neuro ICU. And, you know, sometimes we'll get like a like a random person that's actually never been in a hospital, but they they just applied at the right time when we there was a need. I think I think one of the nurses had SNF background only, and it was she was probably a year into nursing, but there was a need that needed to be filled, and you know, she was trainable and my manager hired her. So I really don't know exactly what you know what any management or HR is looking for. I think at the same time it mat it really matters like the time and what the business need is, but generally they like to see at least one year bedside experience and you know, sniff, you're at the bedside. Um you just have to have like some kind of clinical experience is you're you're gonna have to picture yourself reading the chart notes. And if you've never experienced it in real first hand, you really wouldn't know what to look for with like reviewing cases. So I think aside from certifications, what really matters is some kind of like bedside experience.
SPEAKER_01Okay, and but now in your new role, you do you interact with a patient at all, or is it all doctors, nurses?
SPEAKER_00There are a few times well, we'll have to call a member or a patient, but it's very, very rare. The majority of my day-to-day is all through my laptop, all through emails, all through messages, through teams and whatnot. I hardly talk to patients. It's mostly on the provider side and that team that I would collaborate with.
SPEAKER_01Okay. That's good to know for nurses that are, you know, that I want to work from home. But if you're somebody who really loves that patient interaction, this like wouldn't be a great fit.
SPEAKER_00No. I would honestly say if you are looking for patient interaction, I won't, I won't say you won't ever get it, but in my 11 years, I've probably spoken to maybe five patients. And maybe it was because I just needed to verify something before I reviewed, but it wasn't like actual care provided. It was more like verification. And then the care I'm providing is reviewing, you know, what their doctor said me. So it's not actually one-on-one patient care necessarily, it's just on the other side of it.
SPEAKER_01Yes. And still, you know, you had that nursing background, you have that nursing background, you need that nursing background to do what you're doing. Correct. Yeah. So you bring all that critical thinking and all that experience to what you're doing now. And there are jobs that work from home that you do have patient interaction. It's just the particular one that you're doing is not.
SPEAKER_00Yes, correct. Like my I have a sister, she also does non-bedside, but she works at a like an office setting, but she talks to patients more kind of like an advice nurse line or triage. So there are positions out there that are heavily based on patient interaction telephonically or you know, video like what we're doing now, but that's just I'm on the other side.
SPEAKER_01Yeah. Yeah, that's good. So let's talk about benefits from working from home. What is your schedule? I mean, basically, you don't have to, you know, get in the car and get on the road. So that helps them with gas prices right now.
SPEAKER_00Oh, yes. I'm very thankful to just have a short commute to my desk. Typically, it's Monday through Friday, holidays off, weekends off. My schedule's eight to five. My bosses are very flexible if I need to, you know, leave early or come in later. I mean, I think it really just depends on the company, but for my company, it's eight to five. And I truly enjoy it. I love having a routine. When I worked at the hospital, I had no routine. I kind of just felt like, you know, what day is it? What am I doing today? You know, okay, I have a day off. I just need to like rest. And kind of was just, you know, I was, I was definitely recharging at least a day or two before I can even function my work night shift for a while. And then going to day shift, I was like, okay, cool. I have like a normal sleep cycle. But even then, it was just for me as I got older, I really craved a routine. So I I like I like my schedule now. I have more time for my family. My fiance has a Monday through Friday job, so it works well. We're off on the weekends. If you crave some sort of routine, this would be good for you. I mean, it was definitely hard though to go from having, you know, stretches of days off and having some days off during the week. I mean, I will be saying I will honestly say that is something I do miss from working at bedside was the, you know, the random Tuesday off. But I think where I am in life now, having a very solid routine set schedule, it's more important to me than having that set of seven days off and then not really having that same repetitive routine. So this schedule works for me now.
SPEAKER_01Yeah, and the schedule's important, you know, you're right. There are some nurses that do want to do the 12-hour shifts and have that stretch off, and they plan a lot of different things on there's lots of things on how you can make that stretch even longer. And when you work in a facility that allows it, that you know, that's really good. But then there are other nurses who want that schedule the Monday through Friday because their families or whatever obligations they have, that works.
SPEAKER_00Yes.
SPEAKER_01So and I remember that too. I remember I actually did go to a Monday through Friday position, and I remember missing the random Tuesday where you could like run and do errands or quieter out there, right? You get out there the world is quieter now when you have the Saturday-Sunday, like most people do. People are out there too. Everyone's out there, you know. You go to to have breakfast and you're waiting. It doesn't matter.
SPEAKER_00Yeah. So I guess that you could say that's the one disadvantage, but that would be that is the one thing I do miss, but I I will probably hands down always choose what I my current my current employment than anything else right now.
SPEAKER_01Right, right. It's a it's a give and take. You've got to decide, you know, this whole thing for this podcast is giving nurses different snapshots of what these jobs are that are out there and available to them. And so, you know, if if a lot of nurses want that schedule, that Monday through Friday schedule, and then not having the commute, and so this would be a perfect area to look into.
SPEAKER_00Yes.
SPEAKER_01Yeah. And then there's so many options as far as the work from home positions, and we're gonna be featuring them here on the podcast soon.
SPEAKER_00That's exciting. There's tons of positions out there that a lot of them don't have the word, you know, or the phrase work from home nurse. I mean, it's it's so it's so broad to say work from home nurse, you have to kind of just like know what the jobs are. So, like for me, prior authorization, referral nurse, you wouldn't know that's a work-from-home nurse by just knowing those terms. So I love that you're showcasing other jobs.
SPEAKER_01Yeah, and sometimes when you are on those sites where you do see the work from home jobs, nurses are jumping at them now, and you'll see you can see like 500 applications and then they close it down. So it's kind of nice to know the other names that they're under so that you can go and apply and be, as we always like tell people, try to be one of the first applicants because they close those jobs down, and somebody's gonna get it. So and it might be you, and you know, be ready to find those different words for terms of finding those jobs.
SPEAKER_00And what I like to tell people that are interested is you can definitely look on in Indeed. Like, I I found my job on Indeed, and you know, I went through the temp agency, but now knowing what I know now, I would tell someone, like, look into your local health plans where you live, whether it's a Medi-Cal plan or a Medicare plan or you know, some kind of commercial insurance, I would look into like their actual website and look for their jobs and apply there. And you can like filter it to do prior authorization or to do quality or to do management and just see what jobs pop up because if you're just searching for remote or work from home, you might not find it. So if you search for different words, you could find something.
SPEAKER_01Well, and if you look for the words everybody's looking for, everyone's finding it.
SPEAKER_00Yes.
SPEAKER_01So growth from within, like if you wanted to take your experience that you have from the last 11 years and go somewhere within your organization, what would that look like?
SPEAKER_00So I've been asked many times if I wanted to be a lead, a supervisor, or a manager. And I'm just I I tell everyone I like being a regular nurse. I want to just like be down with my box and go home. So uh there's plenty of opportunities in leadership, or you can do auditing. Once you have your foot in the door and you have at least like I think even six months to one year of doing what I do, you know, they are looking for people that want to take it to the next level as some kind of lead. And with that comes more like reports and like data, you know, trends. If you're into that, um, a lot of abstracting material. And for me, I I kind of like doing the actual work. I love reading about different, you know, like plans of care that doc because I'm I'm essentially reading like the provider's plan of care. Like, oh, this person came in with this, we're gonna do this for them. So every day I'm learning something new, whether it's you know, something I can gain from it or just taking care of my patient or that member. But once you Do decide you want to go for something a little higher up, you you dive more into like the reporting stuff and like the data. So there's that if you're into that.
SPEAKER_01So basically I'm just getting that there's opportunities for you to move within something that you have found that you really like to do.
SPEAKER_00Yes, yes, definitely. So if you're into that, you can do that too if you wanna if you want to move up.
SPEAKER_01Yeah. Okay, well, good. And so I always have to kind of say though, because we, I mean, it sounds wonderful. Maybe there aren't any, but what would you say are some of the challenges of doing this job?
SPEAKER_00So, I mean, there's different challenges. I think if you are, I'm a very social person. So when people find out I work from home, they're like, oh, don't you miss you know, seeing patients and your coworkers and you know, going to lunch meetings and having lunch with your coworkers. And I do. I it's it can be very isolating when you work from home full time. Um, I haven't seen my coworkers in probably a year or two. We used to do like, you know, like yearly get-togethers, but you know, life happens, the schedules don't align. But if you are someone that craves human connection like daily, this this can be a little isolating. I sometimes feel that some people might have like a hard time with like the different learning curve of all these electronics that we you know have to get used to. You have like you have your little system, you have your laptop, then we have these cameras for meetings where they're not monitoring us while we work. But I think the challenges are when you're work from home completely remote, 100%. It can be isolating. I think for me, I have to have like time for me to go outside, walk, you know, go do something, touch grass, I don't know, get out and be in nature. But for me, I I do miss like interacting with my coworkers, but I think that the pros are much more than the cons. A challenge can also be just trying to navigate all the you know, electronic stuff, like getting used to like navigating different systems that you work with, but all that's part of the training, and I think in time you get used to it if you're not used to like all the computer stuff and programs, but you know, just like with anything, the more you do it, the more you get used to it.
SPEAKER_01Okay, okay. So let's finish this sentence.
SPEAKER_00This specialty is good for a nurse who this specialty is good for a nurse who is ready to leave bedside and they're ready to no longer be stuck in traffic all the time or be burnt out from the physical struggles of being a nurse, the pre-shift anxiety that you might experience. You know, you never know what kind of patient you're gonna get. In my job, I can pretty much see all the all my cases ahead of time, and I kind of know what to expect. If you're craving a routine, this is some this is something for you. You might be speaking to every nurse out there, right?
SPEAKER_01So it sounds like your advice though is like really if you want to do it, find it and apply.
SPEAKER_00Yes. And I think also it's really just knowing what to look for. So, like we mentioned earlier, it's just kind of finding the different titles that you know do offer, you know, a work from home position. So I think that would really help someone when they are searching for work from home jobs.
SPEAKER_01I know there's a lot of uh nurses as we close up that are that I talk to also as well, that they're they don't think they have the qualifications to go to apply for this job. For any job, that's what I'll see. Like, oh, I want to go here, but I don't think I have the experience. But you know, any of the jobs in nursing that you want to go to, there is a path and you can strategize to do it. And for this strategy would be to start looking for those words that are actually still what you're gonna do, but you just you know, it can't it's under a different name. And so kind of figure what that is and then apply and and just apply because a lot of it they will train you too.
SPEAKER_00Correct. I I mean, if you want to seek some kind of certification, I would look into prior authorization or utilization management, but you don't have to. I mean, when I applied, had nothing, even job descriptions that I see now, it doesn't have a requirement to be certified in utilization or prior authorization. I haven't I haven't really seen that. And I've looked when I used to kind of do some one-on-one. I would help, you know, people that ask me, like, oh, I I see this position and see, they don't have a requirement to have a certification. You just need to have a bedside experience, you just need to this, this, this, this. So I just wouldn't want anyone to spend extra money to do that because I mean, I can't say it will get you hired because I didn't do that, right?
SPEAKER_01It might, yeah, but I always I do tell nurses too that sometimes it makes you a stronger applicant. Sure, yeah, definitely. Yeah, it's not a bad idea, but there you definitely don't need it to get hired because I talk to alumnurses that'll say the same as you. You know, yeah, didn't need it, I didn't get it, and so you know, you don't and but if you want to get it, I guess go find it and get it. But I you've but you've got some great valuable information here, and I thank you so much. Is there anything you want to add or tell people how to find you?
SPEAKER_00Sure. I definitely help others if they reach out to me via email or DM. My Instagram handle is that Nurse Daisy. I share mostly, you know, my soft nursing life. I do have some resources on my stand store. I'd love to help you out to give you some feedback or just support you in any way I can. And I'm all for nursing nurses trying different specialties.
SPEAKER_01Good. Yeah, it's it's so helpful too for nurses to find their area and because the opportunities are endless and looking. If you're not in a place that is vibing with you, then you know, go out and look and see. And right.
SPEAKER_00I'm yeah, I I always tell people, you know, you went to nursing school not to just survive, but to actually, you know, go and go clock into something that you don't hate going to. You don't want to be miserable working. I mean, we spend a lot of our time working, you might as well actually not hate it, you know. Right. Like I've been there before where I just like, what am I doing? I just feel like I'm just depleted every time I go into this place. Like, right, I mean, that's just not a way to live life, you know. And I have options. There are so many options, and it just really takes you just trying. I mean, the worst that can happen is you don't get hired, but you just keep applying, you just gotta keep searching and applying. I I kid you not, something will open up for you.
SPEAKER_01Yes, I agree. I agree. We'll put your um Instagram on our show notes if so anyone's looking for it. Okay, yeah, sounds good. All right, thanks so much, Daisy. Uh, thanks, Rebecca. Thank you for listening to my nurse specialty. I hope what you heard today gave you real insight into the specialty and helped you see what's possible for your nursing path. If you're watching this on YouTube, please subscribe. And if you're listening on audio, follow the show so you don't miss what's next. If you know a nurse or even a student nurse who's learning about the next steps, tell about the show or some of the steps up. And also, what specialty should we feature next? If you're a nurse in a unique specialty that you'd love to share, apply to be a guest on my website. I'm Coach Rebecca. Until next time, keep exploring.