Remote Utilization Review RN — Flexible Part-Time

Ensemble Health Partners; Northern (KY); Hybrid; USD 63,000 - 95,000; Part time

Benefits offered by this job

Bonus incentives

Shift differentials

Tuition reimbursement

Certifications paid

Comprehensive benefits

Career advancement

Job summary

Ensemble Health Partners is seeking a Utilization Review RN for a remote, part-time opportunity that serves facilities nationwide. You will perform medical necessity reviews and discharge planning to ensure appropriate care levels while coordinating with physicians and the care team.

The role emphasizes collaboration, accuracy, and timely communication, with shift flexibility and a strong focus on patient outcomes across diverse settings.

Qualifications

• Bachelor's degree in nursing and active RN license.
• Three years of nursing experience in acute care preferred.
• Utilization review/discharge planning experience preferred.
• Working knowledge of quality improvement processes preferred.

Responsibilities

• Resource Utilization: identify over/under utilization and refer to physician advisor.
• Medical Necessity Determination: review admissions with criteria and determine status.
• Denial Management: support appeals and monitor denial trends.
• Quality/Revenue Integrity: document and communicate outcomes for FCC and payers.
• Facilitation of Patient Care: prioritize reviews and collaborate with care managers.
• Communication: maintain clear communication with physicians, payors, and team.

Skills

RN license

Utilization review

Medical necessity review

Communication skills

Education

Bachelor's Degree in Nursing

RN license

Job description

Ensemble Health Partners is seeking a Utilization Review RN for a remote, part-time opportunity that serves facilities nationwide. You will perform medical necessity reviews and discharge planning to ensure appropriate care levels while coordinating with physicians and the care team.

The role emphasizes collaboration, accuracy, and timely communication, with shift flexibility and a strong focus on patient outcomes across diverse settings.