RN- Denials/Charge Audits, Full Time, First Shift

UC Health; Cincinnati (OH); On-site; USD 70,000 - 100,000; Full time

Job summary

UC Health in Cincinnati, OH seeks an RN to support data analysis, data mining and quality monitoring under the Director of Quality Management and Informatics. The role focuses on improving quality of care, service levels, revenue realization and cost effectiveness in a clinical setting.

You will collaborate with healthcare teams, engage in population-specific care, and contribute to performance improvement initiatives while maintaining adherence to regulatory standards.

Qualifications

• Minimum Required: Associate degree - RN.
• Other: Diploma Nurse.
• Preferred: Bachelor's Degree - RN.
• LICENSE & CERTIFICATION: Registered Nurse.
• Minimum Required: 1 - 2 Years equivalent experience. Preferred: 3 - 5 Years equivalent experience.
• Experience using insurance platforms/portals: Availity, UHC/Optum, PNM (OH Medicaid), etc.
• Remote work environment experience
• Epic knowledge and experience are a must

Responsibilities

• Engages in population appropriate communication.
• Has knowledge of growth and development milestones and tasks.
• Gives clear instructions to patients/family regarding treatment.
• Involves family/guardian in the assessment, initial treatment and continuing care of the patient.
• Identifies any physical limitations of the patient and deploys intervention when necessary.
• Recognizes and responds appropriately to patients/families with behavioral health problems.
• Interprets population related data and plans care appropriately.
• Identifies and responds appropriately to different needs resulting from, unique psychological needs or those associated with religious / cultural norms. Performs treatments, administers medication or operates equipment safely.
• Recognizes and responds to signs/symptoms of abuse or neglect.
• Performs reviews of patient records for completion of TJC core measure cases. Enters data into Midas system. Prepares reports and other documentation to improve the processes of care. Works with hospital PI committees responsible for improving these processes.
• Performs reviews of patient records to monitor for quality outcomes using population-specific clinical database based on established indicators. Enters all utilization and quality data into the database system as outlined in procedures. Responsible for transmission of data to appropriate registry on a routine basis.
• Identify actual and potential delays in service or treatment and opportunities for improvement (OFI) and refer to the appropriate individuals within the multidisciplinary patient care teams. Receives comparative reports from registry and handles all necessary correspondence and communication with the registry.
• Identifies appropriate data to be collected and assists in formulation of strategies for performance improvements including complications, adverse outcomes, etc. Participates in process improvement teams as developed for this project.
• Serves as a consistent resource regarding project specific quality information and trends. Participates in project related organization wide activities in order to coordinate data analysis efforts. Maintains knowledge of current trends and developments in the field.

Skills

Remote work experience

Insurance portals experience

Education

Associate degree - RN.

Diploma Nurse.

Bachelor's Degree - RN.

Tools

Availity

UHC/Optum

PNM

Epic knowledge

Job description

Job Description

At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.

Job Description

At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering. As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors. UC Health is committed to providing an inclusive, equitable and diverse place of employment. Under the supervision of the Director of Quality Management and Informatics, provides support for data analysis, data mining, and quality monitoring and support improvements in quality of care, service levels, revenue realization and cost effectiveness.

Location

Cincinnati, OH, United States

Qualifications

• Minimum Required: Associate degree - RN.
• Other: Diploma Nurse.
• Preferred: Bachelor's Degree - RN.
• LICENSE & CERTIFICATION: Registered Nurse.
• Minimum Required: 1 - 2 Years equivalent experience. Preferred: 3 - 5 Years equivalent experience.
• Experience using insurance platforms/portals: Availity, UHC/Optum, PNM (OH Medicaid), etc.
• Remote work environment experience
• Epic knowledge and experience are a must

Responsibilities

PATIENT POPULATION - (CLINICAL ONLY):

• Engages in population appropriate communication.
• Has knowledge of growth and development milestones and tasks.
• Gives clear instructions to patients/family regarding treatment.
• Involves family/guardian in the assessment, initial treatment and continuing care of the patient.
• Identifies any physical limitations of the patient and deploys intervention when necessary.
• Recognizes and responds appropriately to patients/families with behavioral health problems.
• Interprets population related data and plans care appropriately.
• Identifies and responds appropriately to different needs resulting from, unique psychological needs or those associated with religious / cultural norms. Performs treatments, administers medication or operates equipment safely.
• Recognizes and responds to signs/symptoms of abuse or neglect.
• Performs reviews of patient records for completion of TJC core measure cases. Enters data into Midas system. Prepares reports and other documentation to improve the processes of care. Works with hospital PI committees responsible for improving these processes.
• Performs reviews of patient records to monitor for quality outcomes using population-specific clinical database based on established indicators. Enters all utilization and quality data into the database system as outlined in procedures. Responsible for transmission of data to appropriate registry on a routine basis.
• Identify actual and potential delays in service or treatment and opportunities for improvement (OFI) and refer to the appropriate individuals within the multidisciplinary patient care teams. Receives comparative reports from registry and handles all necessary correspondence and communication with the registry.
• Identifies appropriate data to be collected and assists in formulation of strategies for performance improvements including complications, adverse outcomes, etc. Participates in process improvement teams as developed for this project.
• Serves as a consistent resource regarding project specific quality information and trends. Participates in project related organization wide activities in order to coordinate data analysis efforts. Maintains knowledge of current trends and developments in the field.