RN - Senior Utilization Review Quality (Remote)

Ensemble Health Partners; Oregon; Hybrid; USD 65,000 - 87,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble Health Partners is seeking an RN Utilization Review Quality professional for a remote nationwide role. You will lead quality reviews, mentor UR teams, and collaborate with leadership to improve processes and patient outcomes.

The position requires an unrestricted RN license (compact preferred) and at least three years of acute care nursing, with UR/discharge planning experience preferred. Travel to client sites may be required as business needs dictate.

Qualifications

• Bachelor's Degree or equivalent experience in Nursing or a related field.
• Current unrestricted RN license required; RN compact license preferred.
• Three years nursing experience in an acute care environment required.
• 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

• Mentor UR Quality Specialist and UR team members to develop skills in the quality review process.
• Assess the Quality Assurance process and identify efficiency improvements for Leadership.
• Evaluate VUR policies/procedures for entry and senior level teams to inform the annual plan.
• Perform quality reviews across multiple clients and host systems; conduct root cause analyses.
• Coordinate with service line leaders and leadership to identify risks and plan reviews.
• Develop understanding of business processes in scope for reviews and document procedures.
• Perform account-level reviews to ensure consistency with best practices.
• Review for compliance with policies, procedures, and workflows.
• Identify operational, compliance, and quality risks and propose mitigations.
• Prepare and present quality findings to leadership for approval.
• Participate in pre- and post-review meetings with actionable recommendations.
• Ensure past recommendations are implemented in current processes.
• Maintain knowledge of laws/regulations regarding medical necessity and compliance.

Skills

Interpersonal communication

Quality improvement

Problem-solving

Organizational skills

Education

Bachelor's Degree or equivalent (Nursing or related field)

Job description

Ensemble Health Partners is seeking an RN Utilization Review Quality professional for a remote nationwide role. You will lead quality reviews, mentor UR teams, and collaborate with leadership to improve processes and patient outcomes.

The position requires an unrestricted RN license (compact preferred) and at least three years of acute care nursing, with UR/discharge planning experience preferred. Travel to client sites may be required as business needs dictate.