Remote Senior RN — Quality & Utilization Leader

Ensemble Health Partners; Ohio; Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Bonus incentives

Tuition reimbursement

Job summary

Ensemble Health Partners is seeking an RN for Senior Utilization Review Quality to oversee quality reviews across multiple clients and provide input to annual workplans. You will mentor UR staff, conduct root-cause analyses, and collaborate with leadership to improve operational and clinical outcomes.

The role requires an unrestricted RN license, 3 years of acute care nursing, and experience in utilization review or discharge planning; travel to client sites may be required.

Qualifications

• Bachelor's Degree or equivalent experience; Specialty/Major: Nursing or related field.
• Current unrestricted RN license required; RN compact license preferred.
• Three years nursing experience in an acute care environment required.
• Utilization review/discharge planning experience preferred.

Responsibilities

• Review and ensure quality of VUR teams’ work in partnership with Leadership Team.
• Onboard support including user provisioning as required.
• Mentor UR Quality Specialists and UR team members.
• Perform root cause analysis on audit findings and denials.
• Coordinate with service line leaders to identify risks and plan reviews.
• Document processes and perform account-level reviews for consistency with best practices.

Skills

Interpersonal skills

Communication

Negotiation

Education

Bachelor's Degree or equivalent

Nursing major

Job description

Ensemble Health Partners is seeking an RN for Senior Utilization Review Quality to oversee quality reviews across multiple clients and provide input to annual workplans. You will mentor UR staff, conduct root-cause analyses, and collaborate with leadership to improve operational and clinical outcomes.

The role requires an unrestricted RN license, 3 years of acute care nursing, and experience in utilization review or discharge planning; travel to client sites may be required.