Remote Utilization Review RN – Pediatric/NICU Focus

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 registered nurse for an Utilization Review role that can be performed remotely within the United States. You will assess medical necessity, coordinate with care teams, and support revenue cycle activities to ensure appropriate care levels and efficient patient flow.

The position requires an RN license, a Bachelor's in Nursing, and at least three years of acute care experience.

Qualifications

• Bachelor's Degree or equivalent experience; Specialty/Major: Nursing or related field.
• Current unrestricted RN license required; RN compact license preferred.
• Three years nursing experience in an acute care environment preferred.
• Utilization review/discharge planning experience preferred.
• Recent experience or working knowledge of medical necessity review criteria preferred.
• Current working knowledge of quality improvement processes.

Responsibilities

• Utilizes proactive triggers to identify potential over/under utilization of services.
• Initiates referral to physician advisor in a timely manner.
• Collaborates with interdisciplinary team to address barriers to patient progress.
• Coordinates with FCC, patient access, and business office on billing issues with third-party payers.
• Provides inpatient/observation clinical reviews for commercial carriers within one business day.

Skills

RN licensure

Clinical assessment

Interdisciplinary collaboration

Communication

Education

Bachelor's Degree in Nursing

RN license

Job description

Ensemble Health Partners is seeking a registered nurse for an Utilization Review role that can be performed remotely within the United States. You will assess medical necessity, coordinate with care teams, and support revenue cycle activities to ensure appropriate care levels and efficient patient flow.

The position requires an RN license, a Bachelor's in Nursing, and at least three years of acute care experience.