Remote Utilization Review Manager - Lead Denials & Appeals

Ensemble Health Partners; United States; À distance; USD 92 000 - 139 000; Plein temps

Avantages offerts par ce poste

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Résumé du poste

Ensemble Health Partners seeks a Manager for Utilization Review to lead the centralized Virtual Utilization Management program, coordinating clinical and operational excellence in authorizations, denials, and appeals for inpatient, observation, and outpatient settings. This remote role requires a nursing license, MCG certification within 6 months, and the ability to travel to client sites as needed.

The position offers strong bonus incentives, paid certifications, tuition reimbursement,

Qualifications

• Current unrestricted nursing license in the resident state.
• MCG Certification required within 6 months of hire.
• Remote position with willingness to travel to client sites as needed.

Responsabilités

• Develops and manages the Medical Management department activities to meet targets.
• Develops a UM work plan and reports to the Director of the Financial Clearance Center and VP.
• Oversees operational activities of the Virtual UM staff.
• Supports Care Coordination to improve LOS and reduce excess days.
• Participates on committees and studies to improve denial/appeal processes.
• Monitors UM staffing productivity and effectiveness.

Connaissances

Decision Making

Courage

Influencing

Coaching & Developing Others

Emotional Intelligence

Creating an Inclusive Environment

Formation

Associate Degree in Nursing

Bachelor's Degree in Nursing

Description du poste

Ensemble Health Partners seeks a Manager for Utilization Review to lead the centralized Virtual Utilization Management program, coordinating clinical and operational excellence in authorizations, denials, and appeals for inpatient, observation, and outpatient settings. This remote role requires a nursing license, MCG certification within 6 months, and the ability to travel to client sites as needed.

The position offers strong bonus incentives, paid certifications, tuition reimbursement,