Guidehouse
Global consultancy delivering advisory, technology & managed services to commercial and government clients.
Remote RN handling clinical denial reviews, appeals, and pre‑service authorizations.
16 days ago
$68,000 - $113,000
Intermediate (4-7 years), Expert & Leadership (13+ years), Experienced (8-12 years)
Full Time
District of Columbia, United States
Hybrid
Company Size
18,000 Employees
Service Specialisms
Financial Management
Grants Management
Analytics & Data Visualization
Cybersecurity
Cloud
Change Management
Program Management
Risk Management
Sector Specialisms
Communities
Energy
Infrastructure
Healthcare
Financial Services
Defense
National Security
Supply Chain
Role
Description
denial analysis
regulatory research
documentation integrity
pre‑service authorization
clinical tool
client presentation
- Conduct comprehensive Denial Root-cause analysis.
- Telephonic communication with payors, provider, hospital staff and patient/family as necessary to bring the account into resolution.
- Research and application of regulatory policies to support clinical appeal.
- Ensure documentation integrity
- Coordinate pre-service authorization approvals
- Utilize Evidence -based clinical guideline tool (Milliman ® or InterQual ®))
- May be required to present oral presentations to client facility or Guidehouse staff and leadership
Requirements
rn license
bachelor’s degree
coding guidelines
microsoft
utilization management
clinical experience
- Attention to detail, strong organizational skills and self-motivated.
- Ability to work under a timeline/deadline & provide clear & accurate updates to project leader of assignment progress, hours worked & expected outcomes daily.
- Ability to make decisions and assimilate multiple data sources or issues related to problem solving independently & accurately.
- 4+ years of clinical experience
- Working knowledge of basic Coding Guidelines.
- Current Registered Nursing License
- Familiarity with medical records assembly & clinical terminology, coding ter minology additionally beneficial.
- Bachelor’s Degree (Relevant experience may be substituted for formal education or advanced degree)
- Technical ability to multi-task on various systems, desktop and Microsoft applications while managing inbound calls.
- Utilization Management Experience
Benefits
- Retrospective Medical Record reviews to assure complete and accurate physician/staff documentation is present to support medical necessity.
- Medical Necessity Reviews
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Short-Term & Long-Term Disability
- Medical, Rx, Dental & Vision Insurance
- Parental Leave
- Corporate Sponsored Events & Community Outreach
- Personal and Family Sick Time & Company Paid Holidays
- Collaboration with hospital Patient Access and Mid-Revenue Cycle
- Basic Life & Supplemental Life
- Employee Referral Program
- 401(k) Retirement Plan
- Position may be eligible for a discretionary variable incentive bonus
- Emergency Back-Up Childcare Program
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Training + Development
Information not given or found
Interview process
Information not given or found
Visa Sponsorship
Information not given or found
Security clearance
Information not given or found
Company
Overview
$3B Annually
Revenue Figures
Generates around $3 billion in annual revenue, demonstrating significant growth over six years.
5x Growth
Growth Metrics
Experienced five-fold growth in revenue over the past six years.
Founded in 2018
Company Origins
Spun off from PwC’s public-sector business, quickly establishing itself as an independent consultancy.
Acquired in 2023
Major Backing
Acquired by Bain Capital late 2023, marking a significant strategic partnership.
- Shifting focus rapidly due to its broad portfolio, dynamic workforce, and innovative delivery network.
- Backed by one of the world's leading private equity firms, enhancing its financial and strategic capabilities.
- Committed to a purpose-driven culture with a focus on attracting, developing, and empowering employees.
- Known for its unique agility among major consultancies, driven by its founding roots and strategic growth through acquisitions.
Culture + Values
- We act with integrity and respect.
- We are results-driven, passionate about driving positive change for clients and communities.
- We innovate through collaboration, leveraging diverse perspectives and expertise.
- We empower our people to excel by fostering an inclusive and supportive environment.
- We commit to delivering sustainable, data-driven solutions for our clients.
Environment + Sustainability
Net Zero 2030
Carbon Emissions Goal
Committed to achieving net zero carbon emissions across operations and services.
- Focus on providing sustainability consulting to help clients transition to cleaner operations.
- Integrated environmental sustainability into business model and client solutions.
- Strives for energy-efficient operations and encourages responsible consumption across global offices.
- Incorporates sustainable practices into supply chain management and procurement strategies.
Inclusion & Diversity
50% by 2025
Gender Parity Goal
Aiming for gender parity in leadership roles by 2025.
3 years
Minority Representation Goal
Aims to increase representation of underrepresented groups in senior roles over the next 3 years.
- Focusing on increasing diversity in the workforce with specific emphasis on underrepresented groups.
- Tracking and reporting on gender diversity metrics regularly to measure progress and outcomes.
- Providing resources and career development initiatives specifically aimed at supporting diverse talent.