Remote Utilization Review Supervisor

Ensemble Health Partners; United States; Remote; USD 84,000 - 126,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble Health Partners is seeking a Virtual Utilization Review Supervisor (RN) to lead utilization review, ensure medical necessity, and drive timely documentation. You will collaborate with physicians, nurses, and coding staff to optimize care and costs across US sites.

This role emphasizes patient-centered outcomes and data-driven improvements. Qualified candidates bring RN licensure, UR/denial management experience, and strong communication skills.

Qualifications

• Current RN license in good standing.
• 1+ year of leadership/coaching experience.
• 2+ years UR experience in healthcare settings.
• 5+ years of nursing in acute care.
• Experience in utilization review or discharge planning.
• Familiarity with medical necessity review criteria is preferred.
• Effective verbal and written communication skills.
• Ability to collaborate across care teams.
• Strong clinical assessment, organization, and problem solving.
• Ability to identify internal/external resources for patient care.
• Proficient with database/spreadsheet tools for reporting.

Responsibilities

• RESOURCE UTILIZATION: identify over/under utilization and coordinate with physicians and hospital staff.
• MEDICAL NECESSITY DETERMINATION: review admissions daily using criteria, communicate outcomes.
• DENIAL MANAGEMENT: assist with appeals and monitor denial trends.
• QUALITY/REVENUE INTEGRITY: document activities and support CMS indicators.
• FACILITATION OF PATIENT CARE: align plan of care with multidisciplinary teams.
• COMMUNICATION: liaison with care teams on non-coverage of benefits.
• TEAM AFFIRMATION: collaborate with peers and departments to meet goals.
• OTHER JOB FUNCTIONS: maintain compliance, participate in meetings, support process improvement.

Skills

RN license

Leadership experience

UR experience

Acute care nursing

Utilization review

Medical necessity criteria

Communication skills

Team collaboration

Clinical assessment

Resource identification

Database & spreadsheet analysis

Education

Bachelor's degree in Nursing preferred; Associate's degree Nursing required

MCG certification or willingness to obtain within 6 months

Job description

Ensemble Health Partners is seeking a Virtual Utilization Review Supervisor (RN) to lead utilization review, ensure medical necessity, and drive timely documentation. You will collaborate with physicians, nurses, and coding staff to optimize care and costs across US sites.

This role emphasizes patient-centered outcomes and data-driven improvements. Qualified candidates bring RN licensure, UR/denial management experience, and strong communication skills.