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CLINICAL INSURANCE SERVICES ANALYST (RN) PD - CARE MANAGEMENT

Department:  Nursing
Status:  Per Diem
Shift:  1st

The Clinical Medicare Services Analyst (RN) will develop and document policies and procedures that are specific to
Medicare 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 Medicare Services
Analyst (RN) will also assist in the management of utilization resources and perform clinical review for requested
Medicare-based medical services.
The Clinical Medicare 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:

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.

 

Preferred: 

Qualified bilingual or multilingual candidates.

 

 


Job Segment: Clinic, Nursing, Medical, Manager, Home Care, Healthcare, Management

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