Location: Los Angeles, California, , United States
Posted: 2021-09-02
Position Title: Patient Access Nurse- Hospital
Company Name: Guidehouse (MLK Community Hospital – South Los Angeles)
Sector: Medical
Job Duration: Indefinite
Guidehouse is a leading global provider of consulting services to the public and commercial markets with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges and navigate significant regulatory pressures with a focus on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that prepare our clients for future growth and success. The company has more than 10,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit: www.guidehouse.com.
Responsibilities
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. Both Full Time and Part Time Positions Available.
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.
Qualifications
- Two years’ experience in utilization review/insurance/case management/medical clearance.
- Previous experience in hospital utilization management (preferably in 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.
Preferred Qualifications:
- Two years’ experience in utilization review with external payors within a hospital or insurance setting.
- Bachelor of Science in Nursing (BSN).
Additional Requirements
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.
Disclaimer
About Guidehouse
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.
For more information contact: susan.goshen@guidehouse.com or call (424) 430-3102.
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.
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