Guidehouse Patient Access Nurse in Los Angeles, California
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The Primary responsibilities of the Patient Access Nurse are to facilitate patient medical and financial clearance using nursing knowledge, clinical judgment, and communication skills to assist in resolving difficulties surrounding patient access and authorization of services. This is a 12- hour shift position from 7:00 PM to 7:00 AM with rotating weekends and holidays.
The ideal candidate will have two or more years’ experience in utilization review with external payors within a hospital or insurance setting.
Duties and Responsibilities:
Consistently and accurately utilizes medical acceptance criteria to screen Emergency Room patients in a way to ensure optimal efficiency in the patient Access operations.
Performs clinical review of all inpatients to determine medical acceptance following the Miliman guidelines and communicates with patients, and physicians who fail to meet medical criteria for acceptance.
Uses excellent oral communication and listening skills to communicate with patient, physician and clinical staff regarding obstacles to access or financial clearance.
Responds to voicemails within one business day and answers phone calls in a timely manner.
Completely and accurately documents communications with payors, patients, and the treatment team.
Two years’ experience in nursing or one-year related nursing experience in utilization review/insurance/case management/medical clearance.
Experience in Hospital Utilization Management (preferably an acute care hospital).
Graduation from an accredited school of nursing.
Current State of California Professional Nursing License (RN)
Ability to read and comprehend English.
Demonstrates excellent customer service skills.
Highly organized and well developed with strong communication skills, oral and written.
Confidence to communicate and outreach to other community health care organizations and personnel.
Demonstrates sound judgment, decision making and problem-solving skills.
Ability to apply principles of process improvement
Must be able to follow detailed instructions and perform repetitious tasks
Computer/basic keyboard skills, telephone skills, and general knowledge of office machines including printers, fax, copier, scanner, and credit card machines required.
Two years’ experience in utilization review with external payors within a hospital or insurance setting.
Bachelor of Science in Nursing (BSN).
Strong conceptual, as well as quantitative and qualitative analytical skills
Work as a member of a team as well as be a self-motivator with ability to work independently
Constantly operates a computer and other office equipment to coordinate work
Regularly uses close visual acuity and operates computer equipment to prepare and analyze and transmit data
Generally works in an office environment
The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.