Utilization Review Registered Nurse at Ensemble Health Partners: 100% Remote (US)
Ensemble Health Partners is hiring a 100% remote Utilization Review Registered Nurse to conduct medical necessity reviews, manage denials, and collaborate on resource utilization. This is a full-time, 4x10 schedule role offering a salary range of $63,100 to $94,650 annually.
Job Description
Role Overview
- Position: Utilization Review Registered Nurse
- Company: Ensemble Health Partners
- Location: 100% Remote (United States)
- Schedule: 4x10 shift schedule with rotating weekends
Key Responsibilities
- Resource Utilization: Utilize proactive triggers to identify potential over/under utilization of services and initiate appropriate referrals.
- Medical Necessity Determination: Conduct medical necessity reviews of all admissions and provide timely clinical reviews for commercial carriers.
- Denial Management: Coordinate the peer-to-peer (P2P) process and maintain documentation relevant to the appeal process.
- Quality and Revenue Integrity: Collaborate with the healthcare team to achieve outcomes management goals and handle assigned work queues.
- Facilitation of Patient Care: Prioritize patient reviews based on medical record review and clinical criteria.
Qualifications & Requirements
- Bachelor's Degree in Nursing or a related field (or equivalent experience)
- Current unrestricted RN license (compact license preferred)
- Three years of nursing experience in an acute care environment preferred
- Utilization review or discharge planning experience preferred
Requirements & Skills
Specialty
Utilization Review
Education
Bachelor
Experience
3+ years
Licenses
RN
Skills
Utilization ReviewMedical NecessityDenial ManagementDischarge PlanningAcute CareRevenue Cycle