Make a direct impact on patient care while working from home. Ensemble Health Partners is hiring Virtual Utilization Review Specialists to evaluate medical necessity, manage resource utilization, and support revenue integrity for hospitals and health systems nationwide.
About Ensemble Health Partners
Ensemble Health Partners is a recognized leader in revenue cycle management, serving hospitals, health systems, and physician groups across the U.S. We deliver technology-enabled solutions that keep hospitals financially healthy so they can focus on keeping communities healthy.
Our culture is built on trust, collaboration, and innovation, with a strong commitment to people-first values. Ensemble has been named Best in KLAS, Fortune Best Workplace in Healthcare, and a Monster Top Workplace for Remote Work.
Schedule
- Full-time, remote (nationwide)
- PRN and part-time weekend roles also available
- Pay range: $28.90 – $35.45 per hour (based on experience)
What You’ll Do
- Conduct medical necessity reviews for admissions, continued stays, and observation status using approved criteria
- Identify potential over/under-utilization of services and collaborate with physician advisors and care teams
- Work with financial clearance, patient access, and business office staff on payer-related billing issues
- Assist with denial management, including documentation, appeals coordination, and trend monitoring
- Record accurate clinical and statistical data in systems (ConnectCare, ADT work queues)
- Monitor for readmissions and collaborate on quality and revenue integrity initiatives
- Maintain timely and professional communication with physicians, nurses, payors, and interdisciplinary teams
- Educate staff and providers on utilization review processes and coverage determinations
- Participate in process improvement teams, departmental meetings, and training sessions
What You Need
- Bachelor’s degree in Nursing or related field (or equivalent experience)
- Current unrestricted LPN or RN license (RN compact license preferred)
- At least 3 years of acute care nursing experience required
- Utilization review or discharge planning experience preferred
- Strong knowledge of medical necessity criteria, quality improvement processes, and CMS guidelines
- Excellent communication, negotiation, and collaboration skills
- Proficiency in clinical assessment, organization, and problem-solving
- Ability to work independently and manage multiple priorities in a fast-paced environment
- High-speed internet access for remote work
Benefits
- Bonus incentives and recognition programs
- Paid certifications and tuition reimbursement
- Comprehensive medical, dental, vision, and retirement plans
- Paid time off, parental leave, and wellness programs
- Career advancement in an award-winning healthcare organization
- Supportive, people-first culture with strong work-life balance
Join a top-ranked healthcare company that empowers you to grow your skills and make a difference.
Happy Hunting,
~Two Chicks…