Virtual Utilization Review Specialist – Weekends – Remote

If you’re a licensed nurse who knows how to read a chart fast, apply medical necessity criteria, and keep payors, physicians, and internal teams moving in the same direction, this weekend schedule is a solid setup. It’s clinical review work with a revenue integrity backbone.

About Ensemble Health Partners
Ensemble Health Partners provides technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They deliver end-to-end revenue cycle services and point solutions to support hospitals and communities.

Schedule

  • Part-time, remote (nationwide)
  • Weekend-focused compressed schedule
  • Part-time schedule: Saturday and Sunday, 10-hour shift each day
  • Note: Part-time schedule requires an Illinois license (per posting)

What You’ll Do

  • Conduct medical necessity reviews for admissions and continued stays using approved clinical criteria
  • Determine appropriate patient status and communicate outcomes to care management and relevant partners
  • Provide inpatient and (as indicated) observation clinical reviews for commercial carriers to the Financial Clearance Center within one business day of admission
  • Identify over/under-utilization risks using proactive triggers (diagnoses, cost criteria, complications) and refer to physician advisor as needed
  • Collaborate with interdisciplinary teams to remove barriers to patient progression and support proper resource utilization
  • Coordinate denial management activities including P2P support and appeal documentation when assigned
  • Track denial trends, assist with denial updates and overturned days, and monitor for readmissions
  • Maintain accurate documentation across payor, physician, FCC, and care management communications
  • Manage assigned revenue cycle workflow queues (ConnectCare and ADT work queues)
  • Maintain professional communication via voicemail, Skype, and email; respond within established guidelines and SLAs
  • Support department goals through teamwork, process improvement participation, and backup coverage as needed

What You Need

  • Current, unrestricted LPN or RN license (required); RN compact license preferred
  • Bachelor’s degree in Nursing or related field, or equivalent experience
  • Ability to work a compressed weekend schedule
  • High-speed internet for remote work
  • Strong clinical assessment, organization, and problem-solving skills
  • Strong communication and negotiation skills with physicians, payors, and interdisciplinary teams
  • Preferred: 5 years acute care nursing experience
  • Preferred: utilization review and/or discharge planning experience
  • Preferred: working knowledge of medical necessity review criteria and quality improvement processes

Benefits

  • RN pay scale: $32.65–$35.85/hour (based on experience)
  • LPN pay scale: $24.65–$26.35/hour (based on experience)
  • Shift differential for select shifts
  • Bonus incentives
  • Paid certifications
  • Tuition reimbursement
  • Comprehensive benefits
  • Career advancement opportunities

If you’re not an RN/LPN with the right license, this one’s a hard no. But if you are, and you can handle the pace and the documentation, it’s a strong weekend-only clinical role.

Happy Hunting,
~Two Chicks…

APPLY HERE.