Sr. Virtual Utilization Review Specialist

We are seeking Senior Virtual Utilization Review Specialists to work in Pacific Time and Mountain Time zones. The role is remote with a weekday schedule of three 12‑hour shifts per week, rotating weekends and holidays.

The Senior VUR Specialist performs resource utilization, medical necessity, denial management, and quality/revenue integrity work, collaborating with physicians, payors, and the financial clearance center. They must hold a current unrestricted LPN or RN compact license and be willing to obtain single-state licensure in Oregon or Alaska.

• Use proactive triggers (diagnoses, cost criteria, complications) to identify over/under utilization.
• Initiate referrals to physician advisors promptly.
• Conduct medical necessity reviews for admissions, including inpatient and observation, using approved criteria.
• Provide inpatient and observation clinical reviews to the Financial Clearance Center within one business day.
• Communicate outcomes to care management staff and coordinate with physicians for needed documentation.
• Coordinate denial management processes (P2P, appeals) and maintain documentation.
• Track denial trends and monitor readmission data.
• Ensure accurate statistical data entry and submit within required time frames.
• Manage Connect Care and ADT work queues and perform second‑level physician reviews.
• Prioritize patient reviews based on clinical assessment and review criteria.
• Collaborate with the in‑house care manager and multidisciplinary team.
• Educate hospital staff on utilization review program and maintain professional demeanor.
• Respond to Voice Mail, Skype, and email in a timely manner and participate in meetings and training.

• Bachelor’s degree or equivalent nursing experience.
• Current unrestricted LPN or RN compact licensure; willingness to obtain Oregon or Alaska single‑state license.
• Three years nursing experience in an acute‑care environment preferred.
• Experience in utilization review or discharge planning preferred.
• Recent knowledge of medical necessity criteria and quality‑improvement processes.
• Excellent interpersonal, communication, negotiation, and organizational skills.
• Strong clinical assessment, problem‑solving, and prioritization abilities.
• Self‑motivated, resourceful, and able to work independently.
• Willingness to travel to client or corporate office as needed.

• Competitive pay based on RN or LPN scale.
• Bonus incentives, tuition reimbursement, comprehensive benefits package (healthcare, time off, retirement, well‑being programs).
• Professional development opportunities and tuition reimbursement for certifications.
• Recognition and incentive programs for performance.

Ensemble is an equal employment opportunity employer. We do not discriminate against any applicant or employee on the basis of race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information, or any other protected class. We provide reasonable accommodations to qualified individuals with disabilities in accordance with applicable law. Contact  for accommodations in the application process.

Compensation decisions consider job‑related factors such as geography, knowledge, skills, experience, education, licensure, internal equity, and time in position.