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.
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.
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.
Two years’ experience in utilization review with external payors within a hospital or insurance setting.
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