Senior Utilization Review Quality RN - Remote

Ensemble Health Partners; Columbus (OH); Remote; USD 85,000 - 105,000; Full time

Benefits offered by this job

Bonus Incentives

Tuition Reimbursement

Job summary

Ensemble Health Partners seeks an experienced RN for Senior Utilization Review Quality to lead quality improvements across VUR teams and partner with Leadership.

You will perform independent account reviews, identify opportunities for improvement, support onboarding, and mentor UR staff while ensuring compliance with medical necessity standards and quality goals in a remote-capable role.

Qualifications

• Bachelor's Degree or equivalent; Nursing or related field preferred
• Current unrestricted RN license required; compact license preferred
• Three years nursing experience in an acute care environment required
• Utilization review/discharge planning experience preferred
• Understanding of medical necessity review criteria preferred
• Strong knowledge of quality improvement processes
• Excellent interpersonal and communication skills in interactions with physicians, payors, and healthcare teams

Responsibilities

• Review and ensure quality of VUR teams’ work in partnership with Leadership Team
• Perform independent account reviews to identify opportunities and recommend improvements to leaders
• Assist with onboarding support including user provisioning in partnership with Leadership Team
• Mentor UR Quality staff to develop skills in quality review processes
• Assess QA processes and identify opportunities to increase efficiency
• Evaluate policies/procedures with input into annual review workplan
• Perform quality reviews across multiple clients and host systems; conduct root cause analysis
• Coordinate with service line leaders to identify risk and develop quarterly/annual review plans
• Document processes and perform account-level reviews for consistency with best practices
• Prepare and present quality findings and recommendations to leadership
• Maintain knowledge of laws/regulations regarding medical necessity and documentation

Skills

RN license

Nursing experience

Communication skills

Customer service

Education

Bachelor's Degree or equivalent

Job description

Ensemble Health Partners seeks an experienced RN for Senior Utilization Review Quality to lead quality improvements across VUR teams and partner with Leadership.

You will perform independent account reviews, identify opportunities for improvement, support onboarding, and mentor UR staff while ensuring compliance with medical necessity standards and quality goals in a remote-capable role.