If you’re an RN or LPN who knows acute care and can think like both a clinician and a revenue protector, this weekend-focused UR role is a solid setup. You’ll handle medical necessity reviews, status determinations, denial prevention, and payer communication in a remote environment.
About Ensemble Health Partners
Ensemble Health Partners provides technology-enabled revenue cycle management solutions for hospitals and affiliated physician groups nationwide, supporting end-to-end revenue cycle operations and related point solutions.
Schedule
- Part-time (Weekend-focused)
- Remote (Nationwide)
- Posted: Yesterday
- Requisition ID: R039846
- Weekend schedule offered:
- Part-time: Saturday + Sunday, 10-hour shifts each day
- (They also list a compressed full-time option: Fri/Sat/Sun 7:00 AM–7:00 PM + a 4-hour shift on Wednesday)
What You’ll Do
- Review admissions for medical necessity using approved clinical criteria (admission status + continued stay reviews)
- Provide inpatient and observation clinical reviews for commercial payers to the Financial Clearance Center within one business day of admission
- Identify over/under utilization using triggers (diagnoses, cost criteria, complications) and refer to physician advisor when needed
- Collaborate with care management, physicians, FCC, patient access, financial counseling, and business office teams to remove barriers to patient progress and resolve payer/billing issues
- Coordinate denial prevention and denial management (including P2P process support and appeal documentation when assigned)
- Track denial updates, overturned days, and report denial trends
- Manage assigned revenue cycle work queues (ConnectCare, ADT) and document all payer, physician, and FCC communications
- Direct physician and patient communication regarding non-coverage of benefits when needed
- Participate in process improvement and provide peer backup support as required
- Maintain current knowledge of regulatory and payer requirements (medical necessity criteria, MS-DRGs, POA, etc.)
What You Need
- Current unrestricted LPN or RN license (required); RN compact license preferred
- High-speed internet for remote work
- Ability to work a compressed weekend schedule
- Strong clinical assessment, organization, problem-solving, communication, and negotiation skills
- Ability to work independently and prioritize in a fast-paced environment
- Education: Bachelor’s degree or equivalent experience (nursing or related field)
Preferred
- 5 years nursing experience in an acute care environment
- Utilization review and/or discharge planning experience
- Recent experience or working knowledge of medical necessity review criteria
- Working knowledge of quality improvement processes
Benefits
- Bonus incentives
- Paid certifications
- Tuition reimbursement
- Comprehensive benefits
- Career advancement
- Shift differential for select shifts
Pay
- RN: $32.65–$35.85/hr (based on experience)
- LPN: $24.65–$26.35/hr (based on experience)
Happy Hunting,
~Two Chicks…
APPLY HERE.