Remote Utilization Review Supervisor (RN) Leader

Ensemble Health Partners; Columbus (OH); Remote; USD 84.000 - 126.000; Vollzeit

Benefits dieser Stelle

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Zusammenfassung

Ensemble Health Partners is seeking a Virtual Utilization Review Supervisor to lead utilization reviews, ensure medical necessity, and drive revenue integrity across the care continuum. You will work with physicians, nurses, and coding professionals to optimize documentation and outcomes from a remote setting in the United States.

The role requires an active RN license, strong leadership, and 5+ years in acute care UR or similar, with experience in CMS criteria and payer interactions.

Qualifikationen

• Current unrestricted RN license required.
• Bachelor's degree in Nursing preferred; Associates degree required.
• MCG certification or willingness to obtain within 6 months.

Aufgaben

• RESOURCE UTILIZATION: identify potential over/under utilization and collaborate with hospital liaison.
• MEDICAL NECESSITY DETERMINATION: conduct daily reviews and determine appropriate level of care.
• DENIAL MANAGEMENT: coordinate appeals and monitor denial trends.
• QUALITY/REVENUE INTEGRITY: document and support CMS indicators and revenue cycle workflows.
• FACILITATION OF PATIENT CARE: align plan of care with interdisciplinary team and monitor outcomes.
• COMMUNICATION: maintain clear communication with physicians, staff, and payors.

Kenntnisse

RN leadership

Healthcare data analysis

Communication

Problem solving

Collaboration

Ausbildung

Associates degree in Nursing

Bachelor's degree in Nursing preferred

MCG certification

Jobbeschreibung

Ensemble Health Partners is seeking a Virtual Utilization Review Supervisor to lead utilization reviews, ensure medical necessity, and drive revenue integrity across the care continuum. You will work with physicians, nurses, and coding professionals to optimize documentation and outcomes from a remote setting in the United States.

The role requires an active RN license, strong leadership, and 5+ years in acute care UR or similar, with experience in CMS criteria and payer interactions.