Patient Access Nurse- (Hospital) - Los Angeles, CA
Los Angeles, CA 
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Posted 1 month ago
Job Description
Job Title
Patient Access Nurse- (Hospital) - Los Angeles, CA
Job ID
11116
Location
Los Angeles, CA
Full/Part Time
Full-Time
Regular/Temporary
Regular
Practice Information

Interested in working with talented people to help develop innovative solutions to some of society's most complex and challenging problems? We are Guidehouse, a leading consulting firm serving the public sector and commercial clients with specialized capabilities in strategy, technology, and risk management. You may not yet know our name, but we have a rich history. Guidehouse is a combination of PwC's former public sector practice and Navigant's deep expertise in energy, financial services and healthcare.

We offer an exciting, fast-paced environment that fosters intellectual growth and rewards individuals based on impact, not tenure. Our firm is at the forefront of an emerging model solving complex problems that stretch across government and private companies, affording our people the opportunity to be on the cutting edge of the consulting profession. By focusing on markets facing transformational change, technology-driven innovation, and significant regulatory pressure, our employees also develop and deploy world class knowledge and problem solving that leads to breakthrough solutions.

Our healthcare segment is comprised of consultants, former provider administrators, clinicians, and other experts with decades of strategy, operational/clinical consulting, managed care services, digital health, revenue cycle management, and outsourcing experience. Professionals collaborate with hospitals and health systems, physician enterprises, payers, government, and life sciences entities, providing performance improvement and business process management solutions that help them meet quality and financial goals. You will make an immediate impact from day one, working with a team to provide end-to-end solutions. We don't simply put band-aids on our client's issues, we are working side-by-side with them. Are up for the challenge?

Business Process Management unites the strengths of four category-leading companies to address the complexities of today's healthcare system. We design, develop and implement integrated, patient-centered solutions for sustained improvements in performance and profitability, working collaboratively across a spectrum of customers that encompasses hospitals, health systems, physician practice groups and payers.

Responsibilities

The Patient Access Nurse- (Hospital) will 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 full time Night Shift position from 7:00 PM - 7:00 AM with rotating weekends/holidays.

Ideal candidate will have two or more years' experience in utilization review with external payors within a hospital or insurance setting.

  • 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 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/LVN).
  • 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:

  • Two years' experience in utilization review with external payors within a hospital or insurance setting.
  • Bachelor of Science in Nursing (BSN).

Special Skills/Knowledge

  • Current Basic Life Support (BCLS) for Health Care Providers from the American Heart Association.
  • MAB/CPI Certified (facility required).
  • Critical thinking, resourcefulness.
  • Knowledge of healthcare delivery systems.

Physical Demands

  • Sit, walk, and stand: may spend up to 25 percent of working time standing/walking.
  • Lift, carry, push, pull: generally not more than ten pounds of force is needed to lift, carry push, or pull objects.
  • Bend, stoop, and kneel: occasional bending and kneeling may be required in troubleshooting equipment/assisting patients.
  • Manual dexterity/wrist and hand repetitions: good manual and finger dexterity is needed; up to 50 percent of working time may be spent using a computer keyboard.
  • Vision, hearing, speaking: must have good visual acuity and depth perception to operate the computer system; speaking and hearing are essential to the communication needs of the position.

Behavior Demands:

  • Must role model positive communication and team relationship skills. Must be able to direct and manage workload with minimal supervision. Demonstrates autonomy and initiative when investigating and solving issues.
  • Must be able to take responsibility for self, accuracy of work, and achievement of goals.
  • Must be able to quickly find common ground and solve problems for the good of all; can solve problems with peers with a minimum of noise; is a team player and is cooperative; easily gains trust and support of peers; encourages collaboration; can be candid with peers.
  • Must spend his/her time and the time of others on what's important; eliminates roadblocks; creates focus.
  • Must complete Health stream (HLC) modules (at hospital & at Navigant) completed by assigned date.
  • Must complete Self-evaluation and give to Supervisor/designee by assigned date.
  • Must attend required meetings, both organizational and departmental.

Population Specific Requirements:

  • Demonstrates knowledge, skill and ability to provide service based on the specific patient population. Demonstrates, modifies and adapts work behavior in meeting the patient's specific needs and/or providing the services required.
  • Demonstrates the ability to focus on the specific needs of the patient population and provide the service needed.
  • Demonstrates appropriate communication skill for the patient population served.

Other:

  • Required to assist the hospital in the event of an internal or external disaster.
  • Supports the flexible needs of the department to accommodate patient volume in all areas of the hospital. This may require assignment to another area of the department and/or shift change.
  • Utilize the time card system consistently and with minor corrections required.
  • Demonstrates reliability and dependability by reporting to work when scheduled and completing full assigned work schedule.
  • Performs all other duties as assigned.

Standards of Excellence:

  • Sense of Ownership
    • Demonstrate personal commitment to quality job performance, a sense of responsibility for high achievement, professional appearance, awareness of current events throughout the hospital, and positive promotion.
  • Positive Attitude
    • Maintains a sense of understanding and compassion at all times while conveying energy and pride in all forms of communication: verbal, written, and non-verbal.
  • Responsiveness
    • Accommodates the needs of others through the use of timely actions, clarification, apologies, considerations, and the offering of additional information.
  • Communication
    • Openly interacts with patients and visitors through greetings and introductions, courteous gestures, engaging listening and feedback in dialog, providing helpful information, and addressing conflict in an appropriate manner.
  • Commitment to Co-workers
    • Cooperatively seeks to support and contribute to the work of others by offering assistance, acknowledging accomplishments, applying fair and respectful treatment, and addressing conflict in an appropriate manner.
  • Privacy/Confidentiality
    • Upholds the information and dignity of the patient in the highest regard through private and appropriate conversations and security procedures such as, logging out of computer screens, and closing doors/curtains.
  • Safety Awareness
    • Keeps work area and surrounding environment clean and safe, reports practices and situations that may cause harm. Follows patient safety, including but not limited to, hand washing and patient identification.
Mental/Physical Requirements
  • 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

EEO/C&B Statement

Additional Requirements

  • This position requires successful completion of a background check and employment verification.
  • 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 . 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.

About Guidehouse

With a unique blend of large firm resources and an entrepreneurial collaborative culture, Guidehouse is where your purpose, passion, and expertise transform organizations. 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 with a focus on markets and clients facing transformational change, technology-driven innovation and significant regulatory pressure. Across a range of advisory, consulting, outsourcing, and technology/analytics services, we help clients create scalable, innovative solutions that prepare them for future growth and success. Headquartered in Washington DC, the company has more than 7,000 professionals in more than 50 locations. If you're passionately motivated to make a difference and deliver exceptional work, we invite you to learn more about your career opportunities at www.guidehouse.com

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
2+ years
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