Nurse CSI Analyst: Clinical Data & Utilization

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

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.