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Coord, Patient Acces/Utilization Review Nurse-Woodlands Regional Care Cente
Houston, TX 77384 United States
The Primary responsibilities of the Patient Access Coordinator is to facilitate patient medical and financial clearance using oncology nursing knowledge, clinical judgment, and communication skills to assist in resolving difficulties surrounding patient access and authorization of services. These duties will include management of Patient Access Specialists and Patient Services Coordinators in two Regional Care Centers in close cooperation with the Patient Access Supervisor.
ESSENTIAL JOB FUNCTIONS:
Consistently and accurately utilizes medical acceptance criteria to screen and schedule appointments for new patients in a way to ensure optimal efficiency in clinic operations.
Provides financial counseling options to patients including cost estimates, payment plans, discounts, and supplemental financial assistance; utilizing medical overrides and account reviews as appropriate.
Make decisions regarding the hiring process in collaboration with the leadership team and staff.
Manage daily staffing coverage to ensure adequate resource coverage for operations
Collects complete and accurate financial data during intake process to ensure appropriate financial screening of new patients and verifies data during new patient registration to ensure compliance with required forms and consents.
Uses technical expertise to obtain insurance information, verify benefits, and secure authorizations.
Performs clinical review of new patient referrals to determine medical acceptance and communicates with patients, referring professionals and MDACC physicians regarding patients who failure to meet medical criteria for acceptance.
Uses clinical knowledge to assist with obtaining medical overrides, developing cost estimates, gaining authorization for services, and coordinating pre-determination processes.
Oral and Written Communication:
Uses excellent oral communication and listening skills to communicate with patient, referral source, MDACC physician and MDACC clinical staff regarding obstacles to access or
Completely and accurately documents communications with payors, patients, and the treatment team.
Job Description-Requirements EDUCATION:
Required: Graduation from an accredited school of nursing.
Preferred: Bachelor's degree in Nursing (BSN).
Required: Two years experience in nursing or one year related nursing experience in utilization review/insurance/case management/medical clearance.
Preferred: Two years oncology nursing experience. Two years experience in utilization review with external payors within a hospital or insurance setting.
LICENSURE/CERTIFICATION: Required: Current State of Texas Professional Nursing license (RN).
Preferred: Certified Case Manager (CCM) by the Commission for Case Manager Certification -OR- Certified Healthcare Access Manager (CHAM) by the National Association of Healthcare Access Management.
Education, training, experience:
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