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Ensemble Health Partners

End-to-end revenue cycle management for hospitals

Utilization Review Manager

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeRemote in USA

About the Job

Requirements

  • Proficient in negotiating complex systems to effect positive change.
  • Possess skills required to run a fiscally responsible program while ensuring constant improvement.
  • Actively involved in process redesign to eliminate excess days and decrease overall length of stay for inpatients.
  • Collaborate with interdisciplinary teams, including physicians, nurse practitioners, physician assistants, and department managers for Revenue.
  • Proficient in communicating clearly and effectively with multiple constituents.
  • Proficient in computer usage, especially database and spreadsheet analysis.
  • Broad knowledge and skilled use of MCG or nursing criteria guidelines.
  • Broad knowledge of insurance regulations and Medicare and Medicaid guidelines.
  • Current unrestricted license to practice nursing in the resident state.
  • MCG Certification required within 6 months of hire.
  • Must reside and be authorized to work within the United States.
  • Must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Responsibilities

  • Develop and manage Medical Management department activities to meet department and corporate targets and goals.
  • Develop a UM work plan annually based on strategic initiatives and departmental goals, and report completed activities to the Director of the Financial Clearance Center, VP for Revenue Cycle Services, and Corporate Director of Care Management services for BSHSI.
  • Oversee operational activities of the Virtual UM staff.
  • Provide direct support and resources to Care Coordination to improve length of stay and excess days.
  • Provide indirect support to the CDS Director to manage and oversee the operational effectiveness of the Clinical Documentation department.
  • Participate on committees and conduct studies as necessary to demonstrate improvement in denial and appeal processes.
  • Track and trend program compliance; collaborate with interdisciplinary teams including physicians, nurse practitioners, physician assistants, and department managers for Revenue.
  • Monitor and evaluate UM staffing productivity and effectiveness.
  • Manage UM denial and appeal staff to decrease inpatient and observation denials, improve appeal outcomes, and address issues resulting in failed bill reports.
  • Collaborate with facility-based Care Coordination staff to maximize appropriate level of care and decrease length of stay.
  • Review the department program to ensure compliance with state and regulatory guidelines.
  • Identify staff development opportunities and evaluation tasks for UM staff.
  • Own UM staff annual employee engagement and develop an active action plan to address issues.
  • Develop the departmental budget with the Director of Utilization Management and AVP of Utilization Management; meet and manage departmental goals and budgets.
  • Negotiate budgetary dollars and full-time-equivalent staffing necessary to support business initiatives and future growth for department sections when needed.
  • Review monthly department budget reports and develop action plans to address budget variances.
  • Perform other duties as assigned.

Desired Qualifications

  • Demonstrated advanced usage of AI and management of teams using AI to improve processes and technology, including exploration, experimentation, and application of AI.

About the Company

Ensemble Health Partners

End-to-end revenue cycle management for hospitals

Ensemble Health Partners provides end-to-end revenue cycle management for hospitals and health systems. It handles the entire process from patient intake to final payment, with teams and technology embedded into the provider's operations and a revenue model tied to performance improvements. The company uses its proprietary EIQ platform (analytics, AI, and workflow automation) to optimize revenue cycle processes, reduce insurance denials, and speed cash collection, managing more than $39 billion in net patient revenue. Its approach differentiates it by being a true managed-services partner with full accountability for financial outcomes and a track record of meeting initial client goals. The overarching goal is to improve healthcare providers’ financial performance so they can focus on patient care.

Company size
5,001-10,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Cincinnati, OH
Founded
2014

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