Senior RN - Utilization Review Quality Lead (Remote)

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

Benefits offered by this job

Tuition reimbursement

Certification programs

Career growth

Job summary

Ensemble Health Partners is seeking an RN Utilization Review quality professional to lead QA efforts within the VUR team. You will mentor staff, evaluate QA processes, and drive improvements across multiple clients and systems.

The role requires an unrestricted RN license, at least three years of acute care nursing experience, and knowledge of medical necessity review criteria. Remote work with travel to client sites is expected, and opportunities for professional development are provided.

Qualifications

• Bachelor's Degree or equivalent; Nursing or 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
• Current knowledge of quality improvement processes

Responsibilities

• Mentor UR Quality Specialists and UR team members to develop skills in the quality review process
• Assess QA processes and identify opportunities to increase efficiency and inform Leadership
• Evaluate VUR policies/procedures for entry level and senior teams and contribute to annual review workplan
• Perform quality reviews across multiple clients and host systems
• Document operational, compliance, and quality risks and propose mitigations
• Prepare and present quality reports to leadership for review and approval
• Support onboarding including user provisioning with Leadership Team
• Maintain knowledge of medical necessity and regulatory requirements related to service line

Skills

Communication

Interpersonal skills

Negotiation

Clinical assessment

Organization

Problem solving

Education

Bachelor's Degree in Nursing

RN License

Job description

Ensemble Health Partners is seeking an RN Utilization Review quality professional to lead QA efforts within the VUR team. You will mentor staff, evaluate QA processes, and drive improvements across multiple clients and systems.

The role requires an unrestricted RN license, at least three years of acute care nursing experience, and knowledge of medical necessity review criteria. Remote work with travel to client sites is expected, and opportunities for professional development are provided.