Job Overview
Location
Remote - Nationwide
Job Type
Full-time
Category
HR & Recruiting
Date Posted
May 13, 2026
Full Job Description
đź“‹ Description
- • The Sr. Virtual Utilization Review Specialist plays a critical role in ensuring appropriate and efficient use of healthcare resources by reviewing patient admissions, determining medical necessity, managing denials, and supporting revenue integrity—directly impacting hospital financial health and patient care quality.
- • Day-to-day responsibilities include conducting medical necessity reviews using approved clinical criteria, coordinating denial management processes, collaborating with interdisciplinary teams to facilitate patient care, maintaining accurate documentation for revenue cycle workflows, and communicating outcomes to care management and financial teams.
- • Ensemble Health Partners is a nationally recognized leader in technology-enabled revenue cycle management, serving hospitals and health systems with a mission to keep communities healthy by keeping hospitals financially strong through innovation, excellence, and a people-first culture.
- • In this role, you will deepen your expertise in utilization review, medical necessity criteria (including MS-DRGs and POA), denial trends, and healthcare reimbursement while developing leadership skills through process improvement initiatives, cross-functional collaboration, and mentorship opportunities—positioning you for advancement in clinical operations or healthcare management.
🎯 Requirements
- • Current unrestricted LPN or RN compact licensure with willingness to obtain single-state licensure in Oregon and Alaska
- • Bachelor’s Degree in Nursing or related field, or equivalent experience
- • Three years of nursing experience in an acute care environment preferred
- • Experience in utilization review, discharge planning, or medical necessity review criteria preferred
- • Strong clinical assessment, organization, problem-solving, and communication skills with ability to work independently and prioritize tasks in a fast-paced remote environment
- • Commitment to exceptional customer service and openness to innovation, including AI, to improve patient and client experiences
🏖️ Benefits
- • Bonus incentives and paid certifications to support professional growth
- • Tuition reimbursement for continued education and skill development
- • Comprehensive benefits package covering healthcare, time off, retirement, and well-being programs
- • Career advancement opportunities through internal mobility and professional development investments
- • Recognition programs including quarterly and annual incentives for high performers
- • Work-life flexibility with remote work options and rotating 12-hour shifts (three per week) with training on weekdays
Skills & Technologies
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About Ensemble Health Partners LLC
Ensemble Health Partners provides revenue cycle management services to hospitals and health systems. The company offers coding, billing, accounts receivable, denial management, and patient access solutions supported by data analytics and automation tools. Clients include academic medical centers, community hospitals, and physician practices across the United States. Ensemble focuses on improving cash collections, reducing administrative costs, and ensuring regulatory compliance within healthcare organizations.
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