Remote Utilization Review RN Lead

Ensemble Health Partners; Columbus (OH); Remote; USD 90,000 - 110,000; Full time

Benefits offered by this job

Bonus incentives

Tuition reimbursement

Job summary

Ensemble Health Partners is seeking a Lead Utilization Review RN to enhance financial, quality, and clinical performance across the patient care continuum. You will lead medical necessity determinations, coordinate discharge planning, and work with physicians, nurses, and coding professionals to ensure accurate documentation and appropriate level of care.

The role requires 5+ years of acute care nursing, experience in utilization review and discharge planning, and strong data skills.

Qualifications

• Current unrestricted RN license is required.
• 5+ years of nursing experience in an acute care environment.
• Experience in utilization review and discharge planning.
• Ability to collaborate with care team and payors.
• Strong analytical skills with database/spreadsheet use.

Responsibilities

• Lead utilization review for admissions and discharge planning.
• Perform medical necessity determinations using approved criteria.
• Coordinate denial management and appeals with care team.
• Collaborate with physicians, nurses, and billing staff.
• Educate staff on case management processes and policies.

Skills

Nursing

Utilization review

Discharge planning

Medical necessity criteria

Data analysis

MS-DRGs

POA

RN license

Education

Bachelor's degree in Nursing

Associates degree in Nursing

Tools

Database software

Spreadsheet software

Job description

Ensemble Health Partners is seeking a Lead Utilization Review RN to enhance financial, quality, and clinical performance across the patient care continuum. You will lead medical necessity determinations, coordinate discharge planning, and work with physicians, nurses, and coding professionals to ensure accurate documentation and appropriate level of care.

The role requires 5+ years of acute care nursing, experience in utilization review and discharge planning, and strong data skills.