Remote Utilization Review Manager — Lead Clinical Efficiency

Ensemble Health Partners

Kentucky

Hybrid

USD 83,000 - 139,000

Full time

2 days ago

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Benefits offered by this job

Comprehensive benefits

Tuition reimbursement

Paid certifications

Career advancement opportunities

Remote work option

Job summary

Ensemble Health Partners seeks a Manager for Utilization Review to lead the centralized Virtual UM Program and ensure clinical and operational excellence. You will oversee UM activities, manage denial/appeal processes, and collaborate with hospital-based UM leaders, physicians, CDS, and Health Information Management to drive improvements.

This remote role requires travel to client sites as needed. Candidates with strong leadership, process redesign, and data-driven decision making will thrive in

Qualifications

Develops and manages Medical Management department activities to meet targets.
Oversees Virtual UM staff and supports Care Coordination to improve LOS.
Reviews the department program to ensure compliance with state and regulatory guidelines.

Responsibilities

Performs data-driven analysis to improve denial/appeal outcomes.
Collaborates with physicians, CDS, HIM, and market leaders to optimize care transitions.
Manages budget and staffing to achieve department goals and future growth.
Supports process redesign to reduce length of stay and avoid excess days.

Skills

Decision Making

Courage

Influencing

Coaching & Developing Others

Emotional Intelligence

Creating an Inclusive Environment

Job description

This remote role requires travel to client sites as needed. Candidates with strong leadership, process redesign, and data-driven decision making will thrive in

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