Virtual Utilization Review Specialist

Ensemble(1 month ago)

RemoteFull TimeMedior$65,300 - $71,700Revenue Cycle

About this role

A Virtual Utilization Review Specialist at Ensemble Health Partners conducts remote clinical reviews to support hospital revenue cycle operations, ensuring appropriate use of healthcare resources and adherence to payer medical necessity criteria. The role supports financial clearance and appeals processes while collaborating with clinical teams, physician advisors, and payors to maintain hospital financial health and quality outcomes.

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Required Skills

Utilization Review
Medical Necessity
Denial Management
Revenue Integrity
Care Coordination
Clinical Assessment
Communication
Documentation
Problem Solving
Quality Improvement

Qualifications

Bachelor's Degree
LPN License
RN License
RN Compact License (preferred)

About Ensemble

ensemblehp.com

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.

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