Utilization Review Supervisor

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $84k - $126k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Ensemble Health Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Private Equity Round on 2022-03

Consulting • Insurance • Logistics

Ensemble Health Partners is a leading provider of revenue cycle management (RCM) services for healthcare organizations. They offer an end-to-end RCM solution that helps hospitals, health systems, and affiliated physician groups optimize their revenue cycles, reduce denials and underpayments, and enhance patient experiences using a combination of expert management and advanced technology. Ensemble Health Partners leverages certified operators and AI to deliver consistent results, improve collections, and support future growth for healthcare providers. They are recognized for their robust client partnerships and commitment to delivering reliable revenue lift and cost savings for their clients.

📋 Description

• Identify potential over/under utilization using diagnoses, cost criteria, and complications • Refer cases to the physician advisor and identify barriers to patient progress • Conduct daily medical necessity reviews for admissions, patient status, and continued stays • Provide inpatient and observation clinical reviews for commercial carriers within one business day of admission • Communicate review outcomes and collaborate with hospital liaisons on documentation, level of care, and education • Coordinate denial appeals and maintain documentation to minimize denial rates • Track denial updates, overturned days, readmission possibilities, and denial trends • Support quality and revenue integrity goals, including CMS indicators and case-management work queues • Record and submit statistical data within required timeframes • Facilitate multidisciplinary patient care plans and continuity of care • Communicate with physicians, nurses, multidisciplinary teams, liaisons, and administration • Educate hospital and medical staff about the case management program • Participate in process-improvement teams, departmental meetings, committees, conferences, and task forces • Provide backup support to departmental staff and comply with confidentiality, patient-rights, regulatory, and payer requirements

🎯 Requirements

• Current unrestricted RN license is required • 1+ year of leadership and/or coaching experience • 2+ years UR experience • 5+ years of nursing experience in an acute care environment required • Experience in utilization review/discharge planning • Recent and working knowledge of medical necessity review criteria experience preferred • Effective verbal and written communication skills • Ability to collaborate with all members of the care team • Strong clinical assessment, organization, and problem-solving skills • Ability to identify appropriate internal and community resources and work collaboratively with healthcare teams, providers, and payors • Ability to organize information quickly, prioritize, and complete multiple tasks • Strong technical skills including database and spreadsheet analysis • Associates degree in Nursing required • Bachelors degree in Nursing preferred • Current MCG certification or willingness to obtain within 6 months of hire • Must reside and be authorized to work within the United States

🏖️ Benefits

• Bonus Incentives • Paid Certifications • Tuition Reimbursement • Comprehensive Benefits, including healthcare, time off, retirement, and well-being programs • Career Advancement • Professional development • Quarterly and annual incentive programs • Work-Life Flexibility • Remote work