[Hiring] RN, Utilization Review @Ensemble Health Partners

Role Description

The RN, Utilization Review performs advanced utilization review functions to ensure compliance with payer requirements and optimize clinical documentation for accurate reimbursement. This role:

• Conducts detailed medical necessity reviews for inpatient and outpatient services.
• Prepares and submits authorization requests.
• Manages complex cases requiring escalation.
• Collaborates with providers, payers, and internal teams to resolve authorization issues.
• Reduces denials and supports revenue integrity.
• Mentors other associates.
• Analyzes denial trends.
• Contributes to process improvement initiatives.
• Applies strong clinical judgment and regulatory knowledge.

Qualifications

• Registered Nurse (RN) license.
• Experience in utilization review or related field.
• Strong clinical judgment.
• Knowledge of regulatory requirements.

Requirements

• Ability to work collaboratively with healthcare providers and payers.
• Strong analytical skills.
• Excellent communication skills.
• Proficiency in medical necessity criteria.

Benefits

• Comprehensive benefits package supporting physical, emotional, and financial health.
• Healthcare, time off, retirement, and well-being programs.
• Professional development opportunities, including certification and tuition reimbursement.
• Quarterly and annual incentive programs for outstanding performance.

Company Description

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

• Five-time winner of “Best in KLAS” 2020-2022, 2024-2025.
• Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024.
• 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024.
• Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024.
• Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023.
• Energage Top Workplaces USA 2022-2024.
• Fortune Media Best Workplaces in Healthcare 2024.
• Monster Top Workplace for Remote Work 2024.
• Great Place to Work certified 2023-2024.