Nurse Auditor - PeriOp Services Admin (QLTY IMPV HC SPEC 4)

The Nurse Auditor has significant knowledge of surgical procedures to understand job functions of clinical staff for the purpose of recognizing and monitoring trends in documentation to ensure compliance and to report up the chain of command to facilitate improvement. The Nurse Auditor applies experience and judgment to determine importance of a situation, set priorities, and use abstract thought to evaluate clinical situations. The incumbent will provide billing and auditing support for the Main OR, CSC and SDSC. The incumbent will review charge documentations on a daily basis, following Federal and State agency and insurance company guidelines. The incumbent will analyze and abstract medical clinical data, review charges, and validate event times, room level charges, and billable medications, supplies and implants. The incumbent acts as a support and resource as needed in the maintenance of computer based material databases as well as the utilization of work tools and processes from Epic Op-time. Participates in staff education related to charting compliance and charge item reconciliation.

Apply By Date: March 14th, 2025 at midnight; interviews may be held at any time.

Minimum Qualifications - For full consideration, applicants are encouraged to upload license and/or certification if required of the position

* Possession of current California RN License
* Graduation from an accredited School of Nursing
* Five (5) years recent Perioperative Nursing experience is required
* Knowledge of regulatory and accreditation standards including, but not limited to JCAHO, CMS, CDPH, NCQA, AORN or similar professional standards preferred.
* Knowledge of OR policies and procedures and AORN standards.
* Knowledge of billing, auditing, and purchasing for the Operating Room.
* Knowledge of insurance company guidelines, as well as billable and non-billable procedures, supplies, etc.
* Knowledge of anatomy and physiology.
* Working knowledge of medical terminology sufficiently to communicate knowledgeably with physicians, nurses, and vendors.
* Advanced knowledge of supplies and prosthesis use in the Operating Room.
* Knowledge of medications, indications, dosage ranges, side effects, and potential toxicity.
* Understanding of the process for government programs and insurance reimbursement.
* Strong analytical and problem solving skills to independently define a problem; Identify the resources available to the problem; create viable solutions and take the action necessary to implement them; and follow through to ensure the problem is resolved to the satisfaction of all parties.
* Excellent communication and listening skills to interact with tack and diplomacy with administrative, physician, and clinical staff at all levels.
* Ability to read, write, speak, and understand the English language and utilize medical terminology appropriately
* Proficient in using standard business software including email and common word processing applications
* Demonstrate error-free prose that conveys meaning to readers with clarity and fluency. Write text that effectively communicates ideas, facts, and/or information to an audience appropriate for the assignment. Apply the conventions of standard written English.
* Must be able to work with adaptability, flexibility, and maintain composure during stressful and/or adverse conditions.
* Knowledge of process improvement methodologies to identify opportunities to streamline workload and reduce operating costs.
* Ability to teach clinical skills. Knowledge of legal implications for clinical practice.

Preferred Qualifications

* CNOR preferred
* BSN Preferred

Key Responsibilities

* 70% - Review/Audit/Reconciliation Responsibilities
* 15% - Customer Service
* 10% - Communication
* 5% - Professional Development and Other Duties

POSITION INFORMATION

* Salary or Pay Range: $8,925.00 - $18,675.00
* Salary Frequency: Monthly
* Salary Grade: Grade 26
* UC Job Title: QLTY IMPV HC SPEC 4
* UC Job Code: 006525
* Number of Positions: 2
* Appointment Type: Staff: Career
* Percentage of Time: 100
* Shift (Work Schedule): 8 hours, Variable Days
* Location: 48X (4868XST)
* Union Representation: 99 - Non-Represented (PPSM)
* Benefits Eligible: Yes
* This position is 100% on-site

Benefits

Outstanding benefits and perks are among the many rewards of working for the University of California. UC Davis offers a full range of benefits, resources and programs to help you bring your best self to work, as well as to help you and your family achieve your health, wellness, financial and career goals. Learn more about the benefits below and eligibility rules by visiting either our handy Benefits Summary for UC Davis Health Employees or Benefits Summary for UC Davis Employees and our Benefits Page.

If you are represented by a union, benefits are negotiated between the University of California (UC) and your union and finalized in a contract. Read your bargaining unit's employment contract, stay abreast of current negotiations and learn about collective bargaining at UC: https://ucnet.universityofcalifornia.edu/labor/bargaining-units/index.html

* High quality and low-cost medical plans to choose from to fit your family's needs
* UC pays for Dental and Vision insurance premiums for you and your family
* Extensive leave benefits including Pregnancy and Parental Leave, Family & Medical Leave
* Paid Holidays annually as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Paid Time Off/Vacation/Sick Time as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Continuing Education (CE) allowance and Education Reimbursement Program as stipulated in the UC Davis Health Policies or Collective Bargaining Agreement
* Access to free professional development courses and learning opportunities for personal and professional growth
* WorkLife and Wellness programs and resources
* On-site Employee Assistance Program including access to free mental health services
* Supplemental insurance offered including additional life, short/long term disability, pet insurance and legal coverage
* Public Service Loan Forgiveness (PSFL) Qualified Employer & Student Loan Repayment Assistance Program for qualified roles
* Retirement benefit options for eligible roles including Pension and other Retirement Saving Plans. More information on our retirement benefits can be found here
* UC Davis cares about building a community, which is why we provide resources to enhance diversity, equity and inclusion as well as Employee Resource Groups (ERGs) to support our staff

Physical Demands

* Standing - Occasional Up to 3 Hours
* Walking - Occasional Up to 3 Hours
* Sitting - Continuous 6 to 8+ Hours
* Lifting/Carrying 0-25 Lbs - Occasional Up to 3 Hours
* Pushing/Pulling 0-25 Lbs - Occasional Up to 3 Hours
* Bending/Stooping - Occasional Up to 3 Hours
* Squatting/Kneeling - Occasional Up to 3 Hours
* Twisting - Occasional Up to 3 Hours
* Reaching overhead - Occasional Up to 3 Hours
* Keyboard use/repetitive motion - Continuous 6 to 8+ Hours

Mental Demands

* Sustained attention and concentration - Continuous 6 to 8+ Hours
* Complex problem solving/reasoning - Continuous 6 to 8+ Hours
* Ability to organize & prioritize - Continuous 6 to 8+ Hours
* Communication skills - Continuous 6 to 8+ Hours
* Numerical skills - Continuous 6 to 8+ Hours
* Constant Interaction - Continuous 6 to 8+ Hours
* Customer/Patient Contact - Continuous 6 to 8+ Hours
* Multiple Concurrent Tasks - Continuous 6 to 8+ Hours

Work Environment

UC Davis is a smoke and tobacco free campus effective January 1, 2014. Smoking, the use of smokeless tobacco products, and the use of unregulated nicotine products (e-cigarettes) will be strictly prohibited on any UC Davis owned or leased property, indoors and outdoors, including parking lots and residential space.

Special Requirements - Please contact your recruiter with questions regarding which activities apply by position

* This is a critical position, as defined by UC Policy and local procedures, and as such, employment is contingent upon clearing a criminal background check(s) and may include drug screening, medical evaluation clearance and functional capacity assessment
* This position is designated as a mandated reporter under CANRA and UC policy, and employment is contingent on compliance with applicable policies, procedures and training requirements

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

Diversity, Equity, Inclusion and Belonging

At UC Davis, we're solving life's most urgent challenges to bring a fuller, healthier, and more resilient world within reach. We grow from every challenge we take on and we don't just maintain - we improve. We recognize that creating an inclusive and intellectually vibrant organization means understanding and valuing both our individual differences and our common ground. The most comprehensive solutions come from the most diverse minds and you belong here. As you consider joining UC Davis, please explore our Principles of Community, our Clinical Strategic Plan and strategic vision for research and education, and our latest efforts to outgrow the expected. The University of California, Davis is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California's Affirmative Action Policy, please visit: https://policy.ucop.edu/doc/4010393/PPSM-20

For the University of California's Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

Because we want you to be seen, our recruiting process at UC Davis fosters authenticity, diversity, and inclusion. Studies have shown that some people may not apply to jobs unless they meet every single qualification. Each unique role at UC Davis has a set of requirements and you could be perfect for this role, or you could be perfect for the next role! Don't meet all the requirements? We still encourage you to apply! #YouBelongHere

To learn more about our background check program, please visit: https://hr.ucdavis.edu/departments/recruitment/ucd/selection/background-checks