Remote Senior RN - Quality & Utilization Review

Ensemble Health Partners; Columbus (OH); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Bonus Incentives

Tuition Reimbursement

Job summary

Ensemble Health Partners is seeking a Senior Utilization Review Quality RN to lead independent account reviews of VUR teams, identify opportunities, and communicate improvements to leadership. The role supports training, onboarding, and ongoing quality assurance across multiple clients.

The ideal candidate holds an RN license with at least three years in acute care, with UR/quality improvement experience and strong communication skills.

Qualifications

• Bachelor's Degree or equivalent experience; 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
• Recent experience or working knowledge of medical necessity review criteria preferred
• Current working knowledge of quality improvement processes
• Excellent interpersonal and communication skills; negotiation skills with physicians, payors, and healthcare team

Responsibilities

• Review and ensure quality of VUR teams' work in collaboration with Leadership Team
• Assist with training, education and action plans to maintain quality
• Onboard support including user provisioning with Leadership Team
• Mentor UR Quality Specialist and UR team members
• Assess QA processes and identify efficiency improvement opportunities
• Develop understanding of business processes and perform account-level reviews for consistency with policies
• Prepare and present quality reports to leadership for review and approval

Skills

RN license

Interpersonal skills

Quality improvement

Root cause analysis

Education

Bachelor's Degree in Nursing

Job description

Ensemble Health Partners is seeking a Senior Utilization Review Quality RN to lead independent account reviews of VUR teams, identify opportunities, and communicate improvements to leadership. The role supports training, onboarding, and ongoing quality assurance across multiple clients.

The ideal candidate holds an RN license with at least three years in acute care, with UR/quality improvement experience and strong communication skills.