Remote Utilization Review Leader

Praxy; Northern (KY); Remote; USD 92,000 - 139,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble is seeking a Manager for Utilization Review to lead the centralized Virtual Utilization Management Program. You will guide authorization, denials, and appeals for inpatient, observation, and outpatient cases, collaborating with risk, coding, and care management teams.

Requires a nursing license and an associate degree, with a certification (MCG) due within six months. This remote role may require travel to client sites or corporate offices as needed, and offers strong growth in a

Qualifications

• 2 Year/Associates Degree Nursing or higher is required.
• Current unrestricted nursing license in the resident state is required.
• MCG Certification must be obtained within 6 months of hire.

Responsibilities

• Develops and manages the Medical Management department activities to meet department and corporate targets and goals.
• Based upon strategic initiatives and departmental goals develops a UM work plan annually and reports completed activities to the Director of the Financial Clearance Center, VP for Revenue Cycle Services and the Corporate Director of Care Management services for BSHSI.
• Oversees operational activities of the Virtual UM staff and provides direct support to Care Coordination to improve LOS and excess days.
• Participates on committees and conducts studies to demonstrate improvement in Denial/Appeal processes.
• Monitors and evaluates UM staffing productivity and effectiveness.
• Manages UM staff to decrease IP/OBV denials and improve appeal outcomes.
• Collaborates with facility-based Care Coordination to maximize appropriate level of care and decrease LOS.

Education

2 Year/ Associates Degree Nursing

Job description

Ensemble is seeking a Manager for Utilization Review to lead the centralized Virtual Utilization Management Program. You will guide authorization, denials, and appeals for inpatient, observation, and outpatient cases, collaborating with risk, coding, and care management teams.

Requires a nursing license and an associate degree, with a certification (MCG) due within six months. This remote role may require travel to client sites or corporate offices as needed, and offers strong growth in a