Remote Utilization Review RN – Denials & Care

Ensemble Health Partners; United States; Remote; USD 63,000 - 95,000; Full time

Benefits offered by this job

Bonus incentives

Shift differentials

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble Health Partners is seeking a remote Utilization Review RN to join our health system-focused team. The role conducts medical necessity reviews, collaborates with FCC, care management, and billing colleagues, and supports denial management while maintaining CMS compliance.

Requires a Bachelor's degree (or equivalent) and an active RN license; Epic EMR experience is preferred. Competitive salary and benefits with bonuses and tuition reimbursement offered.

Qualifications

• Bachelor's Degree or equivalent; Specialty/Major: Nursing or related field.
• Current unrestricted RN license; RN compact license preferred.
• Utilization review experience preferred.
• Knowledge of CMS guidelines and MS-DRGs preferred.

Responsibilities

• Perform utilization review and medical necessity determinations.
• Collaborate with FCC, care management, and billing teams.
• Communicate review outcomes to care management and payors.
• Support denial management and appeals documentation.
• Maintain CMS indicators and data accuracy.

Skills

Utilization review

Epic EMR

Critical thinking

Communication

Education

Bachelor's degree or equivalent experience

RN license

Tools

Epic EMR

Job description

Ensemble Health Partners is seeking a remote Utilization Review RN to join our health system-focused team. The role conducts medical necessity reviews, collaborates with FCC, care management, and billing colleagues, and supports denial management while maintaining CMS compliance.

Requires a Bachelor's degree (or equivalent) and an active RN license; Epic EMR experience is preferred. Competitive salary and benefits with bonuses and tuition reimbursement offered.