Sr. Virtual Utilization Review Specialist - WEEKENDS

📋 Description

• • The Sr. Virtual Utilization Review Specialist role is critical to ensuring appropriate use of healthcare resources, supporting patient care quality, and maintaining revenue integrity for Ensemble Health Partners’ clients across the nation. This position directly impacts hospital efficiency and patient outcomes by conducting timely medical necessity reviews and coordinating care transitions.
• • Day to day, the specialist conducts medical necessity reviews of admissions using approved clinical criteria, identifies over/under utilization of services through proactive triggers, collaborates with physicians and care teams to clarify documentation, manages denial processes, and ensures accurate data submission for revenue cycle workflows—all while working remotely on a compressed weekend schedule (Friday–Sunday or Saturday–Monday, 7:00 AM–7:00 PM with a Wednesday shift).
• • Ensemble Health Partners is a nationally recognized leader in technology-enabled revenue cycle management, serving hospitals and health systems with end-to-end solutions. The company is committed to innovation, customer obsession, and excellence, as reflected in its multiple ‘Best in KLAS’ awards and recognition as a top workplace for remote work and healthcare excellence.
• • In this role, you will deepen your expertise in utilization review, medical necessity determination, and denial management while gaining experience with clinical review criteria, MS-DRGs, and payer regulations. You’ll have opportunities to earn certifications, receive tuition reimbursement, and advance your career within a growing organization that values professional development and innovation.