[Hiring] Utilization Review RN @Ensemble Health Partners

Role Description

Ensemble is seeking a dedicated nurse to join our Utilization Review team. This role involves:

• Resource Utilization: Identifying potential over/under utilization of services and collaborating with the interdisciplinary team.
• Medical Necessity Determination: Conducting reviews of admissions and communicating outcomes to relevant parties.
• Denial Management: Coordinating the appeal process and monitoring denial trends.
• Quality/Revenue Integrity: Collaborating with healthcare team members to achieve management goals.
• Facilitation of Patient Care: Prioritizing patient reviews and maintaining communication with care managers.
• Communication: Educating staff about the utilization review program and maintaining professional communication.
• Team Affirmation: Collaborating with peers to achieve departmental goals and participating in process improvement.
• Other Job Functions: Complying with policies, maintaining clinical competency, and participating in departmental activities.

Qualifications

• Bachelor's Degree or equivalent experience in Nursing or related field.
• Current unrestricted RN license required; RN compact license preferred.
• Three years nursing experience in an acute care environment preferred.
• Utilization review/discharge planning experience preferred.
• Recent experience or working knowledge of medical necessity review criteria preferred.
• Current working knowledge of quality improvement processes.

Requirements

• Excellent interpersonal, communication, and negotiation skills.
• Strong clinical assessment, organization, and problem-solving skills.
• Ability to prioritize and complete multiple tasks effectively in a fast-paced environment.
• Resourceful and able to work independently.
• Must be inquisitive and open to innovation.
• Willingness to travel to client or corporate office locations as needed.

Benefits

• Bonus Incentives.
• Shift Differentials.
• Paid Certifications.
• Tuition Reimbursement.
• Comprehensive Benefits.
• Career Advancement.
• 10% weekend differential for hours worked on weekends.
• 10% shift differential for hours worked during the 12:00 p.m. - 10:00 p.m. shift.