Virtual Utilization Review Manager

ensemblehp; United States; Remote; USD 92,000 - 139,000; Full time

Benefits offered by this job

Bonus incentives

Paid certifications

Tuition reimbursement

Comprehensive benefits

Career advancement

Job summary

Ensemble is seeking a Manager for Utilization Review to lead the centralized Virtual Utilization Management Program and ensure clinical and operational excellence in authorization, denials, and appeals for inpatient, observation, and outpatient services.

The role collaborates with hospital-based UM leaders, coding, care coordination, and clinical documentation teams to drive continuous improvement and data-driven solution development within the Revenue Cycle Services framework.

Qualifications

• Experience leading utilization management programs and teams.
• Strong ability to negotiate and influence across departments.
• Proven track record of improving denial/appeal outcomes.

Responsibilities

• Develops and manages the Medical Management department activities.
• Plans UM work program annually and reports progress to senior leaders.
• Oversees Virtual UM staff and supports Care Coordination to improve LOS.
• Collaborates with CDS, HIM, and other health-team members on data and solutions.
• Drives process redesign to eliminate excess days and improve efficiency.

Skills

Decision Making

Courage

Influencing

Coaching & Developing Others

Emotional Intelligence

Inclusive Leadership

Job description

Ensemble is seeking a Manager for Utilization Review to lead the centralized Virtual Utilization Management Program and ensure clinical and operational excellence in authorization, denials, and appeals for inpatient, observation, and outpatient services.

The role collaborates with hospital-based UM leaders, coding, care coordination, and clinical documentation teams to drive continuous improvement and data-driven solution development within the Revenue Cycle Services framework.