Registered Nurse (RN), Denials/Charge Audits, Perioperative, First Shift at UC HEALTH LLC in Cincinnati, Ohio

Job Description:

UC Health is hiring a Registered Nurse (RN)-Denials/Charge Audits for Surgery admissions for First Shift (8am-5pm) at West Chester. This is a remote position.

Under the supervision of the Director of Business Operations, provides support for data analysis, data mining, and
quality monitoring and support improvements in quality of care, service levels, revenue realization and cost effectiveness.

Unit Details:

• Enjoy work-life balance with a work-from-home schedule!
• Learn the behind-the-scenes processes for the perioperative department.
• Join a culture that wants you to succeed and thrive in your role.

• Current OH RN License


• Associate of Science in Nursing (ASN), required


• Bachelor of Science in Nursing (BSN), preferred


• Perioperative Registered Nurse Experience, preferred


• Effective written and verbal communications. Ability to interpret medical data as documented.


• Quality management, utilization management or case management preferred.


• Current knowledge of rules, regulations, policies and procedures related to third party payors, TJC, CMS and other regulatory agencies.


• Knowledge of evidence-based practice and principles, care plan development and core measures.


• Knowledge and training in computer systems to perform position responsibilities such as EPIC, Midas, Microsoft Office products preferred.


• Training in Six Sigma, Analytical thinking and Lean methodology preferred.

• 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.

• 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.