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Date: May 31, 2019

Location: Newport Beach, CA, US

Company: Hoag Memorial Hospital Presbyterian

Job Description:

The Clinical Insurance Services Analyst (RN) will develop and document policies and procedures that are specific to Medicare/Commercial insurance cases, ensuring the provision of quality health care services to patients and the efficient utilization of resources for Hoag Hospital and its affiliates (the “Organization”). This includes creating polices and procedures, based on departmental needs and presenting them to the utilization review committee. The Clinical Insurance Services Analyst (RN) will also assist in the management of utilization resources and perform clinical review for requested medical services provided. The Clinical Insurance Services Analyst (RN) displays and practices a work-style reflecting the mission, vision and values of the Case Management team, as well as the Organization. Participates in the continuous quality improvement process. Maintains a working knowledge of departmental standard operating procedures, including the use of specialized instrumentation, Quality Control requirements, and preventive maintenance.


Qualifications - Education, Training and Experience: 

Required Clinical Insurance Services Analyst (RN): 

• Currently licensed as a Registered Nurse within the State of California 

• Minimum of five (5) years Case Management experience, preferably within an acute healthcare environment. 

• Minimum of two (2) years experience in Utilization Management, Discharge Planning, Case Management or Home Care. Certification as a CCM is a definite plus


Skills or Other Qualifications: Required 

• Self-directed individual with ability to prioritize multiple tasks and meet deadlines, excellent attention to detail, and maintain a high level of work quality. 

• Strong team player with excellent oral, verbal and presentation communication skills. 

• Proven ability to interface with all customer levels (physicians, Organizational staff, insurance companies, patients and family members). 

• Working knowledge of Microsoft Office Suite, including Outlook, Word, Excel, and PowerPoint, plus healthcare database systems. 

• Decisive and capable of exercising good judgment under pressure. 

• Ability to analyze and integrate complex medical information and make sound decisions. 

• Resourcefulness as demonstrated by the effective application of professional knowledge to new situations. 

• Demonstrated ability to make sound decisions based upon established guidelines. 



• Qualified bilingual or multilingual candidates

Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Nursing, Medical, Manager, Home Care, Registered Nurse, Healthcare, Management

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