Remote Utilization Review Supervisor

NurseRemotely; 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 is seeking a Virtual Utilization Review Supervisor to support an outcomes-oriented care delivery system across the organization. The role improves medical record documentation quality and reflects services rendered, with strong interaction among physicians, nurses, and coding professionals.

The position emphasizes utilization review criteria, cost awareness, and CMS indicators while guiding case management workflows.

Qualifications

• Current unrestricted RN license is required.
• 1+ year of leadership and/or coaching experience.
• 2+ years UR experience.
• 5+ years of nursing experience in an acute care environment required.
• Experience in utilization review/discharge planning.
• MCG criteria knowledge or experience preferred.
• Strong verbal and written communication skills.
• Ability to collaborate with care team members.
• Strong clinical assessment and problem-solving abilities.
• Ability to organize information and manage multiple tasks.
• Proficient with databases/spreadsheets.

Responsibilities

• RESOURCE UTILIZATION: Identify over/under utilization; refer to physician advisor; collaborate with hospital liaison and billing teams.
• MEDICAL NECESSITY DETERMINATION: Conduct daily medical necessity reviews; provide inpatient/observation reviews; communicate outcomes.
• DENIAL MANAGEMENT: Coordinate appeals; monitor denial trends; track readmissions.
• QUALITY/REVENUE INTEGRITY: Collaborate to CMS indicators; document data for statistics; manage revenue-cycle work queues.
• FACILITATION OF PATIENT CARE: Prioritize patient care needs and develop plans in coordination with care teams.
• COMMUNICATION: Manage non-coverage communications; educate staff; ensure timely responses.
• TEAM AFFIRMATION: Collaborate with peers; participate in process improvement; provide back-up support.
• OTHER JOB FUNCTIONS: Maintain policies, confidentiality, and regulatory knowledge; participate in meetings.

Skills

RN license

Leadership experience

UR experience

Nursing experience

Utilization review

Medical necessity criteria

Communication skills

Team collaboration

Clinical assessment

Resource assessment

Organization skills

Technical skills - databases/spreads

Education

BSN preferred / ADN required

Job description

Ensemble is seeking a Virtual Utilization Review Supervisor to support an outcomes-oriented care delivery system across the organization. The role improves medical record documentation quality and reflects services rendered, with strong interaction among physicians, nurses, and coding professionals.

The position emphasizes utilization review criteria, cost awareness, and CMS indicators while guiding case management workflows.