Remote Utilization Review RN — Pediatric/NICU

Ensemble Health Partners

Blue Ash (OH)

On-site

USD 63,000 - 95,000

Full time

4 days ago

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Benefits offered by this job

Bonus incentives

Shift differential

Tuition reimbursement

Comprehensive benefits

Job summary

Ensemble Health Partners is seeking an experienced RN for our remote Utilization Review team. You will conduct medical necessity reviews, coordinate care, and collaborate with the FCC, physicians, and care managers to optimize patient outcomes and appropriate utilization.

This is a remote role with potential onsite travel as needed and a 4x10 schedule with weekend rotation. Requires current unrestricted RN license (compact preferred) and 3 years of acute care utilization review or discharge

Qualifications

Current unrestricted RN license required; RN compact license preferred.
Bachelor's degree in nursing or related field or equivalent experience.
Three years of nursing experience in an acute care environment; utilization review/discharge planning preferred.

Responsibilities

Utilize clinical criteria to determine medical necessity and appropriate level of care.
Coordinate P2P processes with physicians, FCC, and care managers to address denials and utilization.
Document reviews, communicate outcomes, and support billing and patient access teams.
Collaborate with interdisciplinary team to optimize resource use and patient care.