17 Utilization Management Nurse Interview Questions and Answers

Utilization management nurses, also called UM nurses, are RNs who work with insurance companies to ensure that patients are getting the most effective and efficient care possible. UM nurses use their clinical knowledge to review patient records and make sure that the care being provided is medically necessary and is being delivered in the most cost-effective way possible.

If you’re a nurse who is interested in working in utilization management, you may be wondering what the interview process is like. What kind of questions will you be asked? What should you wear? How can you make a good impression?

We’ve put together this guide to help you prepare for your utilization management nurse interview. In it, you’ll find sample questions and answers, tips on what to wear, and advice on how to make a good impression.

Are you comfortable working with patients who have complex medical needs?

Utilization management nurses often work with patients who have complex medical needs. An interviewer may ask this question to learn more about your experience working in these situations. In your answer, try to share a specific example of how you helped a patient manage their care plan and stay within their insurance coverage limits.

Example: “I’ve worked with many patients who have complex medical needs throughout my career as a utilization management nurse. For instance, I once had a patient who was on multiple medications for different conditions. I worked with the patient to create a care plan that would allow them to take all of their medications while staying within their insurance coverage limits. This process took some time, but we eventually found a solution that worked well for the patient.”

What are some of the most important skills for an effective utilization management nurse?

This question can help the interviewer determine if you have the skills necessary to succeed in this role. When answering, it can be helpful to mention a few of your own personal skills and how they relate to utilization management nursing.

Example: “I believe that an effective utilization management nurse needs excellent communication skills, problem-solving abilities and attention to detail. These are all important skills for any nurse, but I think they’re especially important when working with patients who may need assistance navigating their insurance plans or understanding what services they qualify for. In my last position, I helped develop a system where nurses could communicate with patients about their benefits before they even met them. This allowed us to answer many questions before they were asked, which made our job easier.”

How would you manage a patient who is overusing healthcare services?

This question can help interviewers assess your ability to manage patients who may be abusing their healthcare benefits. In your answer, try to show that you are empathetic and willing to work with the patient to find a solution that is beneficial for them while also protecting the organization’s resources.

Example: “I would first talk to the patient about why they are using so many services and what I think might be causing it. If I feel like there is an underlying issue that needs to be addressed, I will refer them to another department or resource where they can get the care they need. If not, I will explain how overusing our services affects other patients and how we have to limit certain services as a result.”

What is your process for evaluating the quality of care a patient has received?

This question can help the interviewer understand how you apply your knowledge of utilization management to ensure patients receive quality care. Use examples from your experience that show how you use data and information to make decisions about patient care.

Example: “I evaluate a patient’s quality of care by looking at their medical record, including any test results or diagnoses they’ve received. I also look at the plan of care for each patient, which is usually determined by the physician who oversees their treatment. If there are any discrepancies between these two documents, I will contact the physician to discuss them so we can work together to provide the best possible care for our patients.”

Provide an example of a time when you had to advocate for a patient who was being mistreated by a doctor or nurse.

When answering this question, it can be helpful to mention a specific example of when you helped a patient who was being mistreated by another medical professional. This shows the interviewer that you are willing to stand up for your patients and ensure they receive quality care.

Example: “I once had a patient who came in with a broken arm. The doctor ordered an X-ray but didn’t want to wait for the results before setting the bone. I explained to him that we should wait for the X-ray results because there were other possible injuries that could occur if he set the bone without knowing what else was wrong. He ignored me and proceeded to set the bone anyway. Luckily, nothing more serious happened, but I would have felt terrible if something worse had occurred.”

If a patient was receiving the wrong type of care, how would you identify the issue?

This question can help the interviewer determine how you use your utilization management skills to ensure patients receive the right care. Use examples from your experience that show how you used your critical thinking and problem-solving skills to identify a mistake and fix it.

Example: “In my last role, I noticed one of our patients was receiving home health services when they should have been in an assisted living facility. After speaking with the patient’s physician, we discovered the patient had recently lost his spouse and wanted to stay at home longer than he should have. We worked with the patient to find a suitable assisted living facility and ensured he received all the care he needed.”

What would you do if you suspected that a doctor was prescribing treatments without properly consulting the patient’s chart?

This question can help the interviewer assess your ability to work with other medical professionals and ensure that patients receive proper care. In your answer, demonstrate how you would approach this situation in a professional manner while maintaining positive relationships with all involved parties.

Example: “I have worked with many doctors throughout my career, so I understand that they may forget to check their patient’s chart before prescribing treatment. However, if I noticed that a doctor was doing this regularly, I would speak with them about it privately. If they continued to do so after our conversation, I would report the issue to my supervisor or risk management department.”

How well do you perform under pressure?

This question can help the interviewer determine how well you perform in a high-pressure environment. Utilization management is often an intense role, so it’s important to show that you’re comfortable with pressure and have experience handling it.

Example: “I’ve worked in utilization management for five years now, so I’m used to working under pressure. However, I find that my ability to stay calm helps me remain focused on the task at hand. In fact, I think my previous employer would agree that I am one of their most reliable employees when it comes to performing under pressure.”

Do you have experience working with a team of other medical professionals?

Utilization management is a collaborative role that requires input from many different medical professionals. The interviewer wants to know if you have experience working with others and how well you collaborate. Use examples of your teamwork skills in your answer, such as:

Example: “I’ve worked on several teams throughout my career, including the utilization review committee at my previous hospital. I find it helpful to get feedback from other team members because we all see patients differently. For example, one nurse may notice that a patient has trouble walking while another notices they are late for their appointment. We can use this information to make better decisions about care.”

When is it appropriate to seek a second opinion?

As a utilization management nurse, you may be responsible for determining whether or not patients should receive certain treatments. In some cases, these treatments can be quite expensive and require approval from insurance companies before they’re covered. When answering this question, it can be helpful to provide an example of when you sought a second opinion in the past and how that decision helped your patient.

Example: “In my experience as a utilization management nurse, I’ve found that seeking a second opinion is most appropriate when there’s uncertainty about a treatment plan. For instance, if a doctor recommends a specific treatment but doesn’t explain why it’s best for their patient, I’ll ask them to elaborate on their reasoning. If they can give me more information about why they think the treatment is beneficial, then I’m comfortable approving it. However, if they don’t have any additional information, I’ll seek a second opinion from another utilization management nurse.”

We want to improve our patient satisfaction rates. What would you do to achieve this?

Patient satisfaction is an important metric for healthcare facilities. Interviewers want to know that you can help improve this metric and make the facility more successful. In your answer, explain how you would use your interpersonal skills to build relationships with patients and their families. Explain how you would also use your analytical skills to identify areas of improvement in patient care.

Example: “I believe that improving patient satisfaction rates starts with building strong relationships with patients and their families. I would take time each day to speak with patients about their experience at our facility. I would ask them what they liked and disliked about their care so far. I would also ask if there was anything we could do better to make their stay more comfortable.

I would also work with my team to find ways to improve patient care. For example, if a patient said they were unhappy with the food options, I would talk to the cafeteria staff to see if there was something we could change. If a patient mentioned that they wanted more privacy during treatment, I would talk to other nurses to see if there was a way we could accommodate them.”

Describe your process for calming down a stressed or upset patient.

When working with patients, it’s important to be compassionate and empathetic. This question is asking you how you would react in a situation where a patient was upset or stressed out about their medical care. Use your answer to show the interviewer that you have strong interpersonal skills and can help calm down an upset patient.

Example: “When I first meet a patient, I always ask them what they’re most worried about. If they are stressed or upset, I try my best to listen to them and reassure them that everything will be okay. I also explain all of the steps we’ll take to ensure they get the best treatment possible.”

What makes you an ideal candidate for this position?

Employers ask this question to learn more about your qualifications and how you can contribute to their team. Before your interview, make a list of all the skills and experiences that make you an ideal candidate for this role. Focus on highlighting your relevant education and experience as well as any transferable skills.

Example: “I am passionate about helping patients receive the best care possible. I have worked in healthcare for five years now, and my goal is to continue working with patients who need help managing their medications. In my previous position, I helped develop a medication management program that reduced hospital readmissions by 20%. This makes me confident that I can do the same here.”

Which medical software programs are you most familiar with using?

Utilization management nurses must be familiar with a variety of medical software programs. This question helps the interviewer determine if you have experience using the specific software they use at their facility. Before your interview, research which software systems the hospital uses and review any job descriptions to see if these are listed. If you don’t find any information about the company’s preferred software, consider asking what it is during the interview.

Example: “I am most experienced with Meditech and EpicCare software systems. I worked in an emergency room for three years where we used both of these programs. In my current role as a nurse manager, our hospital implemented EpicCare, so I’ve had to learn that system. However, I’m still comfortable using Meditech.”

What do you think is the most important aspect of utilization management?

This question is your opportunity to show the interviewer that you understand what utilization management entails and how it can benefit a healthcare facility. Your answer should include an explanation of why this aspect is important, as well as examples of how you have applied it in previous roles.

Example: “The most important part of utilization management is ensuring that patients receive the care they need while also keeping costs low for the hospital. In my last role, I worked with a team of nurses who were responsible for reviewing patient records and determining which ones would be appropriate for treatment by lower-cost providers. We used our knowledge of each provider’s qualifications to make sure we only referred patients to those who could provide them with quality care at a reasonable price.”

How often do you update your knowledge of medical developments?

This question can help interviewers understand how much you value your education and the importance of continuing to learn. It also helps them determine whether you are likely to stay with their organization for a long time or if you will leave soon after completing your training.

Example: “I am always looking for ways to improve my skills as a nurse, so I regularly attend seminars and webinars about new medical developments. In fact, I have taken several courses on utilization management in the past year, which is why I am interested in this position. I know that working here would allow me to put my knowledge into practice.”

There is a nationwide shortage of a specific medication that your patient needs. What is your strategy for obtaining more supplies?

This question is an opportunity to show your problem-solving skills and ability to work with other healthcare professionals. Your answer should include a specific example of how you used your communication skills to solve the issue.

Example: “I would first contact my patient’s physician to see if they have any extra supplies. If not, I would then reach out to all of the physicians in our hospital system to see if anyone had extra medication. If there are no extra supplies available within our facility, I would call every nearby hospital to see if they have any extra supplies. If none of them do, I would contact the state government to see if they could help us obtain more supplies.”