Utilization Review Supervisor

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $84k - $126k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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

• Supervise virtual utilization review activities supporting financial, quality, and clinical performance • Facilitate medical record documentation improvement and completeness • Utilize proactive triggers to identify potential over- or under-utilization of services • Refer cases to the physician advisor and identify barriers to patient progress • Conduct daily medical necessity reviews for admissions, patient status, and continued stays • Perform inpatient and observation clinical reviews for commercial carriers within one business day of admission • Communicate review outcomes and collaborate with hospital liaisons on documentation, education, and level-of-care opportunities • Coordinate denial appeals, maintain appeal documentation, monitor denial trends, and report readmissions • Collaborate with healthcare teams to achieve outcomes management goals, including CMS indicators • Maintain case management work queues and accurately record and submit statistical data • Facilitate multidisciplinary patient care plans and continuity of care • Communicate benefit non-coverage issues and educate hospital and medical staff • Participate in process improvement teams, departmental meetings, conferences, committees, and task forces • Provide backup support to departmental staff and comply with hospital, department, confidentiality, and patient-rights policies

🎯 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 preferred • Effective verbal and written communication • Collaborative ability with all members of the care team • Strong clinical assessment, organization, and problem-solving skills • Ability to assess and identify appropriate internal and community resources • Ability to work collaboratively with healthcare teams, providers, and payors • Ability to organize information, prioritize, and complete multiple tasks effectively • Strong technical skills including database and spreadsheet analysis • Associate's degree in Nursing required • Bachelor's degree in Nursing preferred • Current MCG certification or willingness to obtain within 6 months of hire

🏖️ Benefits

• Bonus Incentives • Paid Certifications • Tuition Reimbursement • Comprehensive healthcare, time off, retirement, and well-being benefits • Career Advancement • Professional certification relevant to the field for each associate • Quarterly and annual incentive programs • Work-life flexibility • Remote work