CSI ANALYST/SYSTEM SUPPORT-MVH/FT

Premier Health Partners; Dayton (OH); On-site; USD 75,000 - 110,000; Full time

Job summary

Premier Health Partners seeks a CSI Analyst in the Center for Status Integrity. The role requires a BSN and Ohio RN licensure with 3–5 years' experience in case management or utilization review, focusing on clinical status and reimbursement controls.

The CSI Clinical Analyst collaborates across care teams to ensure appropriate resource use and to prevent denials, using data-driven insights and payer guidelines.

Qualifications

• Bachelor's degree in Nursing and an Ohio RN license.
• 3–5 years of job-related experience in case management or utilization review.
• Knowledge of InterQual and MCG guidelines or similar.
• Experience with utilization management and case management.
• Understanding of hospital reimbursement and third-party payor rules.

Responsibilities

• Analyze clinical status and utilization data to support appropriate care decisions.
• Collaborate with Denials Management, revenue cycle, and ICM to reduce denials.
• Monitor indicators and feedback to improve clinical and financial outcomes.
• Assist in ensuring regulatory compliance and alignment with payer requirements.
• Communicate recommendations clearly to care teams and leadership.

Skills

Interpersonal skills

Conflict resolution

Assertive communication

Analytical thinking

Education

BSN (Bachelor of Science in Nursing)

Tools

EPIC

MS Word

MS Excel

Job description

Title: CSI Analyst - position requires a Bachelor's degree of Nursing (BSN)

Unit: Center for Status Integrity

Hours: 7a-4:30p

Status: Full time, 72 hours per pay period

Facility: System support - MVH

Position Summary

The CSI Clinical Analyst is a registered professional nurse with knowledge and expertise in process analysis, clinical outcome data analysis, utilization management, utilization of information systems and regulatory requirements. The CSI Clinical Analyst is knowledgeable regarding changes in care delivery and their impact on third party reimbursement. The CSI Clinical Analyst’s role is to support clinical and financial integration across the continuum and while insuring the organizations clinical and financial integrity.

The CSI Clinical Analyst works collaboratively with staff from Denials Management, Corporate Compliance, revenue cycle, Integrated Care Management (ICM), physicians, and other internal and external customers. The CSI Clinical Analyst is responsible for ensuring the appropriate use of hospital resources including appropriate status assignment, meeting third party payor clinical review requirements, and working with the ICM team, physicians, and Denials Management team to prevent denials. The CSI Clinical Analyst identifies trends in inappropriate application or utilization of services and potential lost reimbursement for these services. The CSI Clinical Analyst is knowledgeable of third-party payor contracts, Medicare/Medicaid guidelines, and other regulations impacting the approval or denial of services.

Qualifications

Education: Bachelor's of Nursing degree

Licensure/Certification/Registration: Registered nurse with valid Ohio license. Certification in area of clinical specialty preferred

Experience Required: 3 - 5 years of job-related experience

Prior job title or occupational experience: Case management, utilization review, clinical nurse

Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations

Other experience requirements: Minimum 1 year experience with utilization management, case management and knowledge of InterQual and MCG OR 5 years’ relevant adult clinical experience. Process improvement experience.

Knowledge/Skills

Personal computer skills required, including use of Microsoft Word, Microsoft Excel, EPIC

Experience in gathering information, monitoring indicators, and feedback mechanisms is required.

Strong Interpersonal Skills Required

Ability to research, evaluate information, analyze problems and make appropriate recommendations required

Demonstrated Conflict Resolution Skills Required

Assertive communication skills required