Utilization Review RN: Medical Necessity & Denials

Ensemble Health Partners; Kentucky; Hybrid; USD 63,000 - 95,000; Full time

Benefits offered by this job

Bonus incentives

Shift differentials

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble Health Partners is seeking a qualified Utilization Review RN to support our nationwide health system clients. This role focuses on medical necessity determinations, admissions reviews, and collaboration with care management and financial clearance teams.

The position operates on a 4x10 schedule with rotating weekends, offering shift differentials and a comprehensive benefits package. A current compact RN license is required or must be willing to obtain one.

Qualifications

• Must hold current compact RN license or be willing to obtain.
• Experience in Utilization Review or denial management preferred.
• Ability to work a 4x10 schedule with weekend rotation.

Responsibilities

• Utilize proactive triggers to identify over/under utilization of services.
• Communicate medical necessity reviews to care management and FCC teams.
• Coordinate with physician advisor, FCC, and revenue cycle to address denials and billing issues.
• Document all reviews, communications, and actions for compliance and audit readiness.
• Support parse and prioritize patient reviews based on clinical status and criteria.
• Participate in departmental meetings and improvement initiatives.

Skills

RN license

Healthcare analytics

Interdisciplinary collaboration

Education

Registered Nurse license (RN)

Job description

Ensemble Health Partners is seeking a qualified Utilization Review RN to support our nationwide health system clients. This role focuses on medical necessity determinations, admissions reviews, and collaboration with care management and financial clearance teams.

The position operates on a 4x10 schedule with rotating weekends, offering shift differentials and a comprehensive benefits package. A current compact RN license is required or must be willing to obtain one.