Remote Utilization Review Nurse

Ensemble Health Partners; Columbus (OH); Remote; USD 63,000 - 95,000; Full time

Benefits offered by this job

10% weekend differential

10% shift differential

Premium pay opportunities

Job summary

Ensemble Health Partners is seeking an experienced RN for Utilization Review to assess medical necessity and optimize hospital and patient care. This remote role involves coordinating with the FCC, care management, and interdisciplinary teams to ensure appropriate level of care across cases.

The candidate should hold an active RN license with 3+ years of acute care experience and knowledge of utilization review processes.

Qualifications

• Bachelor's Degree in Nursing is required.
• Current unrestricted RN license is required.
• Three years nursing experience in an acute care environment is preferred.
• Utilization review/discharge planning experience is preferred.
• Current working knowledge of quality improvement processes is preferred.

Responsibilities

• Utilizes proactive triggers to identify over/under utilization of services.
• Initiates appropriate referral to physician advisor in a timely manner.
• Collaborates with interdisciplinary team to optimize patient care and resource use.
• Coordinates with financial clearance center, patient access, and business office regarding billing issues with third party payers.
• Maintains documentation and supports readiness for reviews and appeals as needed.

Skills

RN licensure

Utilization review

Communication skills

Team collaboration

Education

Bachelor's degree in Nursing

Tools

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Job description

Ensemble Health Partners is seeking an experienced RN for Utilization Review to assess medical necessity and optimize hospital and patient care. This remote role involves coordinating with the FCC, care management, and interdisciplinary teams to ensure appropriate level of care across cases.

The candidate should hold an active RN license with 3+ years of acute care experience and knowledge of utilization review processes.