Remote RN: Senior Utilization Review Quality Lead

Ensemble Health Partners

United States

Remote

USD 65,000 - 87,000

Full time

7 days ago

Be an early applicant

Get a reply from this employer

Your resume and cover letter, tailored to exactly what they’re hiring for.

Get past ATS filters

Benefits offered by this job

Bonus Incentives

Paid Certifications

Tuition Reimbursement

Comprehensive Benefits

Career Advancement

Job summary

Ensemble Health Partners is seeking an RN, Senior Utilization Review Quality to lead quality reviews for the VUR team. You will partner with leadership to drive improvement, ensure medical necessity review accuracy, and maintain compliance across multiple clients using diverse host systems.

You will mentor colleagues, analyze QA processes, and help implement training and onboarding support. This remote role may require occasional onsite travel to client locations as business needs demand.

Qualifications

Bachelor's Degree or equivalent; Nursing or related field.
Current unrestricted RN license; RN compact license preferred.
Three years nursing experience in an acute care environment.
Utilization review experience preferred; knowledge of medical necessity review criteria.

Responsibilities

Mentor UR Quality Specialists to strengthen review skills.
Assess QA processes; identify opportunities to improve efficiency.
Review policies for entry and senior levels; contribute to annual plan.
Perform quality reviews across multiple clients and hosts; analyze audit findings.
Coordinate with leaders to address risk and plan quarterly/annual reviews.
Document processes; ensure consistency with VUR best practices.
Prepare quality reports and present findings to leadership.
Support onboarding and user provisioning with Leadership Team.