Virtual Utilization Review Specialist – Remote (Full-Time)

Help ensure patients receive the right level of care, at the right time, for the right length of stay — all while working from home.


About Ensemble Health Partners
Ensemble Health Partners delivers technology-enabled revenue cycle management solutions to hospitals, health systems, and physician groups nationwide. Known for innovation, collaboration, and award-winning service, Ensemble empowers its teams to make every healthcare interaction meaningful.


Schedule & Pay

  • Remote, nationwide (full-time and PRN positions available)
  • $28.90–$35.45/hour (based on experience)
  • Bonus incentives, paid certifications, tuition reimbursement
  • Comprehensive benefits and career advancement opportunities

Key Responsibilities

Resource Utilization & Medical Necessity

  • Use clinical triggers to identify over/under-utilization of services
  • Review admissions for medical necessity and appropriate patient status
  • Provide timely inpatient and observation reviews to the Financial Clearance Center
  • Collaborate with physicians, care managers, and other stakeholders to support appropriate levels of care

Denial Management

  • Coordinate peer-to-peer reviews with physicians and advisors
  • Maintain documentation to reduce denial rates and track trends
  • Monitor readmissions and ensure compliance with payer requirements

Quality & Revenue Integrity

  • Accurately record and submit required data
  • Manage ConnectCare and ADT work queues
  • Ensure thorough documentation of communications, authorizations, and review outcomes

Facilitation of Patient Care

  • Prioritize reviews based on patient status and clinical needs
  • Work closely with in-house care managers to support care planning
  • Demonstrate knowledge of patient age-specific needs and growth/development principles

Communication & Collaboration

  • Provide clear coverage determinations to physicians and patients
  • Maintain professional, timely communication with all stakeholders
  • Participate in departmental improvement initiatives and provide back-up support as needed

Qualifications

  • Bachelor’s degree in Nursing or related field (or equivalent experience)
  • Current unrestricted LPN or RN license required (compact license preferred)
  • Minimum 3 years acute care nursing experience
  • Utilization review or discharge planning experience preferred
  • Strong clinical assessment skills, attention to detail, and ability to work independently
  • High-speed internet required

Benefits

  • Health, dental, and vision coverage
  • 401(k) with company match
  • Paid time off and holidays
  • Tuition reimbursement and professional certifications
  • Quarterly and annual recognition programs

Awards & Recognition

  • 5× “Best in KLAS” Winner (2020–2022, 2024–2025)
  • Top Workplace for Remote Work (Monster, 2024)
  • Fortune Best Workplaces in Healthcare (2024)
  • Great Place to Work Certified (2023–2024)

Happy Hunting,
~Two Chicks…

APPLY HERE