Remote Utilization Review Manager — Lead Denials & Appeals

Ensemble Health Partners; Ohio; 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 Utilization Management Program and coordinate with hospital partners and physician advisors. The role oversees authorization, denials, and appeals for inpatient and outpatient services, with collaboration across Coding, Care Coordination, and Health Information Management.

Remote work is allowed, with travel to client sites as needed.

Qualifications

• Decision making: gather, analyze, interpret information to choose best action.
• Courage: confront difficult issues and take bold action.
• Influencing: persuade stakeholders to accept outcomes and actions.
• Coaching & developing others: support growth and unlock potential.
• Emotional intelligence: build trust through understanding emotions and adapting behavior.
• Creating an inclusive environment: leverage diverse backgrounds and perspectives.

Responsibilities

• Develops and manages Medical Management department activities to meet targets.
• Develop UM work plan annually and report to senior leaders.
• Oversee operational activities of the Virtual UM staff.
• Provide direct support to Care Coordination to improve LOS.
• Oversee Clinical Documentation and other related departments.
• Identify staff development opportunities and annual engagement plan.
• Develop departmental budget with senior leaders and secure necessary resources.

Skills

Decision Making

Courage

Influencing

Coaching & Developing Others

Emotional Intelligence

Creating an Inclusive Environment

Education

Associate degree in Nursing

Bachelor’s degree in Nursing

Job description

Ensemble Health Partners is seeking a Manager for Utilization Review to lead the centralized Virtual Utilization Management Program and coordinate with hospital partners and physician advisors. The role oversees authorization, denials, and appeals for inpatient and outpatient services, with collaboration across Coding, Care Coordination, and Health Information Management.

Remote work is allowed, with travel to client sites as needed.