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Sr. Virtual Utilization Review Specialist at Ensemble - ApplyBlast

Sr. Virtual Utilization Review Specialist

Ensemble

4 months ago

4.0 on Glassdoor

Remote

Full Time

Executive

0 applicants

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About this role

Virtual Utilization Review Specialists at Ensemble review medical admissions and determine the medical necessity of care for commercial payers. This role collaborates with physicians, care management teams, and financial centers to manage denials, ensure quality outcomes, and optimize resource utilization across hospitals and physician groups. The position requires a strong clinical background and the ability to work in a virtual environment while maintaining close coordination with on-site stakeholders.

Responsibilities

Conduct medical necessity reviews for hospital admissions
Coordinate appeal processes for denied claims with physicians
Monitor readmission rates and denial trends for quality
Collaborate with interdisciplinary teams on patient care resources
Maintain accurate documentation for regulatory compliance

Skills

Qualifications

BS in Nursing or Related FieldRN LicenseLPN License3 Years Acute Care ExperienceUtilization Review Experience

About Ensemble

ensemblehp.com

Headquarters

Cincinnati, Ohio, United States

Company Size

10001+ employees

Founded

2014

View Profile

Ensemble Health Partners is a revenue cycle management company that partners with hospitals, health systems and physician practices to optimize financial performance. They deliver end-to-end RCM services—patient access, coding and clinical documentation improvement, billing and collections, denials management and revenue integrity—backed by analytics and consulting. Ensemble combines operational teams and technology-enabled insights to accelerate cash flow, reduce write-offs, and improve patient financial engagement.