Senior RN Utilization Review Quality Specialist

Ensemble Health Partners

Blue Ash (OH)

Remote

USD 65,000 - 87,000

Full time

6 days ago

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Job summary

Ensemble Health Partners is seeking an experienced RN to join our Senior Utilization Review Quality team. You will review and ensure quality of VUR work across multiple clients and host systems, identifying opportunities for improvement and coaching junior members.

Reporting to the Leadership Team, you will mentor staff, perform root-cause analyses, and help develop annual review plans while staying current on medical necessity guidelines and compliance standards.

Qualifications

Bachelor’s degree or equivalent in nursing or related field.
Current unrestricted RN license; RN compact license preferred.
Three years of nursing experience in an acute care environment.
Utilization review/discharge planning experience preferred.
Strong interpersonal and communication skills.

Responsibilities

Mentors UR Quality Specialist and team members to develop skills in quality review.
Assesses QA processes and identifies opportunities to increase efficiency.
Performs quality reviews across multiple clients and host systems; conducts root cause analyses.
Coordinates with leaders to identify risks and helps develop review plans.
Supports onboarding and user provisioning with Leadership Team.
Documents risks and presents quality findings to leadership for review.