Remote RN Utilization Review Supervisor

Ensemble Health Partners; Ohio; Remote; USD 84,000 - 126,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble Health Partners is seeking an experienced RN-focused professional to lead case management and utilization review efforts in a fast-paced healthcare setting. You will drive medical necessity determinations, coordinate with hospital teams, and support revenue cycle activities to optimize patient care and financial outcomes.

We offer bonus incentives, paid certifications, tuition reimbursement, comprehensive benefits, and clear opportunities for career advancement.

Qualifications

• Current RN license required or equivalent nursing credential.
• 1+ year of leadership and/or coaching experience.
• 2+ years UR experience in utilization management or case review.
• 5+ years of nursing experience in an acute care environment.
• Experience in utilization review/discharge planning.
• Familiarity with medical necessity review criteria and CMS inspections.

Responsibilities

• Coordinate resource utilization and referrals with hospital teams and payers.
• Perform medical necessity reviews for admissions and continued stay; communicate outcomes.
• Support denial management and monitor trends; assist in readmissions analysis.
• Document and manage data for revenue cycle and case management workflows.
• Collaborate with care teams to plan and adjust patient care pathways.

Skills

Leadership

Communication

Problem solving

Team collaboration

Organization

Education

Associate's degree in Nursing

Bachelor's degree in Nursing

Job description

Ensemble Health Partners is seeking an experienced RN-focused professional to lead case management and utilization review efforts in a fast-paced healthcare setting. You will drive medical necessity determinations, coordinate with hospital teams, and support revenue cycle activities to optimize patient care and financial outcomes.

We offer bonus incentives, paid certifications, tuition reimbursement, comprehensive benefits, and clear opportunities for career advancement.