Remote Lead Utilization Review RN

Ensemble Health Partners; United States; Remote; USD 54,000 - 73,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Job summary

Ensemble Health Partners is seeking a Lead Utilization Review RN for a remote, nationwide role. You will guide the UR process, oversee audits, and collaborate with physicians, nurses, and payors to ensure medical necessity and appropriate level of care.

This role emphasizes leadership in discharge planning, denial management, and outcomes reporting, with opportunities for certifications and tuition reimbursement. Minimum education includes a BSN preferred; US-based candidates only.

Qualifications

• Current RN license (unrestricted) in the United States.
• 5+ years of nursing experience in an acute care environment; UR/discharge planning experience preferred.
• BSN preferred; ADN required.

Responsibilities

• RESOURCE UTILIZATION: identify over/under utilization and refer to physician advisor.
• MEDICAL NECESSITY DETERMINATION: conduct daily reviews using criteria for admissions and continued stay.
• DENIAL MANAGEMENT: support appeals and track denial trends.
• DISCHARGE PLANNING: assess needs and coordinate timely discharge and post-acute care.
• QUALITY/REVENUE INTEGRITY: document data for CMS indicators and revenue workflows.
• FACILITATION OF PATIENT CARE: ensure appropriate plan of care with the care team.
• COMMUNICATION: manage non-coverage communication and educate staff.
• TEAM AFFIRMATION: collaborate, support peers, and participate in process improvements.
• OTHER JOB FUNCTIONS: maintain policy compliance, confidentiality, and training.

Skills

RN license

Clinical assessment

Discharge planning

Communication

Quality improvement

Education

Bachelor's degree in Nursing

Associates degree in Nursing

Job description

Ensemble Health Partners is seeking a Lead Utilization Review RN for a remote, nationwide role. You will guide the UR process, oversee audits, and collaborate with physicians, nurses, and payors to ensure medical necessity and appropriate level of care.

This role emphasizes leadership in discharge planning, denial management, and outcomes reporting, with opportunities for certifications and tuition reimbursement. Minimum education includes a BSN preferred; US-based candidates only.