Remote Utilization Review Manager

Ensemble Health Partners; Columbus (OH); 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 Health Partners is seeking a Manager for Utilization Review to lead the centralized Virtual UM Program and drive clinical and operational excellence. You will oversee authorization, denials, and appeals for inpatient, observation, and outpatient cases from a remote setting.

You will collaborate with hospital-based UM leaders, physicians, CDS, and Health Information Management to optimize care levels, LOS, and budget planning across the enterprise.

Qualifications

• Current unrestricted nursing license in the resident state.
• 2-year/associate nursing degree required; BSN preferred.
• Experience in utilization management or case management is preferred.

Responsibilities

• Develops and manages Medical Management department activities to meet targets.
• Oversees UM staff and budget; collaborates with Care Coordination and CDS.
• Monitors and improves Denial/Appeal processes; ensures regulatory compliance.

Skills

Decision Making

Courage

Influencing

Coaching & Developing Others

Emotional Intelligence

Creating an Inclusive Environment

Education

Associate Degree Nursing

Bachelor's Degree in Nursing

Job description

Ensemble Health Partners is seeking a Manager for Utilization Review to lead the centralized Virtual UM Program and drive clinical and operational excellence. You will oversee authorization, denials, and appeals for inpatient, observation, and outpatient cases from a remote setting.

You will collaborate with hospital-based UM leaders, physicians, CDS, and Health Information Management to optimize care levels, LOS, and budget planning across the enterprise.