Senior Utilization Review RN Lead

Ensemble Health Partners; United States; Remoto; USD 54.000 - 73.000; Tempo integral

Benefícios oferecidos por esta vaga

Bonus Incentives

Tuition Reimbursement

Comprehensive Benefits

Career Advancement

Resumo da vaga

Ensemble Health Partners is seeking a Lead Utilization Review RN to support medical necessity determinations and discharge planning, ensuring high-quality documentation and appropriate care levels. The role emphasizes collaboration with physicians, nurses, coding professionals, and hospital staff to optimize clinical and financial outcomes.

Qualified candidates will have an RN license and 5+ years in acute care, with experience in utilization review and a strong focus on patient-centered care

Qualificações

• Current unrestricted RN license is required.
• 5+ years of nursing experience in an acute care environment.
• Experience in utilization review and discharge planning.
• Recent and working knowledge of medical necessity review criteria preferred.
• Bachelor's degree in Nursing preferred; Associate's degree required.

Responsabilidades

• Utilizes proactive triggers to identify potential over/under utilization of services.
• Conducts medical necessity reviews for admissions and level of care.
• Coordinates the appeal process and monitors denial trends.
• Evaluates discharge planning needs and coordinates with care teams.
• Collaborates with financial clearance, patient access, and billing teams as needed.
• Maintains documentation reflecting reviews and communications with stakeholders.

Conhecimentos

Clinical assessment

Communication

Team collaboration

Problem solving

Organizational skills

Analytical skills

Formação

Associates degree nursing

Bachelor's degree in Nursing preferred

Ferramentas

Database analysis

Spreadsheet analysis

Descrição da vaga

Ensemble Health Partners is seeking a Lead Utilization Review RN to support medical necessity determinations and discharge planning, ensuring high-quality documentation and appropriate care levels. The role emphasizes collaboration with physicians, nurses, coding professionals, and hospital staff to optimize clinical and financial outcomes.

Qualified candidates will have an RN license and 5+ years in acute care, with experience in utilization review and a strong focus on patient-centered care