Remote Utilization Review Manager

Ensemble Health Partners; United States; 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, ensuring clinical and operational excellence across inpatient, observation, and outpatient areas.

The role requires an active nursing license (BSN preferred) and MCG certification within six months; remote work option with travel to client sites as needed. Competitive compensation and strong benefits are offered.

Qualifications

• Requires an associated degree in nursing or higher.
• Current unencumbered nursing license in the resident state.
• MCG certification within 6 months of hire.
• Remote position with ability to travel for onsite work as needed.
• Ensemble encourages professional certification and tuition reimbursement.

Responsibilities

• Lead the centralized Virtual Utilization Management program.
• Oversee denials/appeals processes and maintain program compliance.
• Collaborate with Care Coordination, CDS, and HIM to improve LOS.
• Develop annual UM work plans and monitor budget and staffing.
• Drive improvements to reduce inappropriate stay and optimize care levels.

Skills

Decision Making

Courage

Influencing

Coaching & Developing Others

Emotional Intelligence

Creating an Inclusive Environment

Education

2 Year/ Associates Degree Nursing

Bachelor's Degree Nursing (4 year)

Job description

Ensemble Health Partners is seeking a Manager for Utilization Review to lead the centralized virtual UM program, ensuring clinical and operational excellence across inpatient, observation, and outpatient areas.

The role requires an active nursing license (BSN preferred) and MCG certification within six months; remote work option with travel to client sites as needed. Competitive compensation and strong benefits are offered.