Remote Utilization Review RN - Flexible Hours & Benefits

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

Benefits offered by this job

Tuition reimbursement

Comprehensive benefits

Remote work with travel

Job summary

Ensemble Health Partners is seeking a remote Utilization Review RN to assess and optimize patient care utilization across services. This role requires an active RN license and at least three years of acute care nursing experience, with experience in utilization review or discharge planning preferred.

Competitive pay with shift differentials and benefits for eligible candidates. The position emphasizes collaboration with care management, payors, and the FCC to ensure medical necessity and

Qualifications

• Bachelor's degree or equivalent experience.
• Current RN license in good standing.
• 3 years nursing experience in an acute care environment preferred.
• Utilization review or discharge planning experience preferred.
• Knowledge of medical necessity criteria and CMS guidelines preferred.
• Strong interpersonal and negotiation skills required.

Responsibilities

• Perform utilization review to identify over/under utilization of services and coordinate with physician advisor.
• Conduct medical necessity reviews for admissions and continued stay using approved criteria.
• Collaborate with FCC, patient access, financial counselors and payors to resolve billing and coverage issues.
• Document outcomes accurately and communicate with care management and interdisciplinary team.
• Support quality and revenue integrity by monitoring denials and reporting trends.

Skills

RN license

Nursing experience

Utilization review

Communication skills

Education

Bachelor's degree or equivalent

Job description

Ensemble Health Partners is seeking a remote Utilization Review RN to assess and optimize patient care utilization across services. This role requires an active RN license and at least three years of acute care nursing experience, with experience in utilization review or discharge planning preferred.

Competitive pay with shift differentials and benefits for eligible candidates. The position emphasizes collaboration with care management, payors, and the FCC to ensure medical necessity and