Hospital Registered Nurse Part Time Flexible Shifts

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. Customer Obsession: Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
Bonus Incentives
Shift Differentials
Tuition Reimbursement
Must have current compact RN license, or be willing to obtain*
Part-Time Schedule Options
2 × 10-hour shifts

1. 8-hour shifts + 1 × 4-hour shift
2. 8-hour shifts

~2 × 10-hour shifts + 1 × 4-hour shift

• We are seeking candidates who are flexible and comfortable working shifts based on business needs. 10% shift differential for hours worked during the 12:00 p.m. - 10:00 p.m. shift .
• 10:00 p.m. shift on a weekend may receive a total 20% differential for eligible hours worked.

Initiates appropriate referral to physician advisor in a timely manner
Understands proper utilization of health care resources and assists with identifying barriers to patient progress and collaborates with the interdisciplinary team
Collaborates with financial clearance center, patient access, financial counselors and/or business office regarding billing issues related to third party payers
Medical Necessity Determination
Conducts medical necessity review of all admissions. Utilizes approved clinical review criteria to determine medical necessity for admissions including appropriate patient status and continued stay reviews, possibly from an offsite location
Provides inpatient and observation (if indicated) clinical reviews for commercial carriers to the Financial Clearance Center (FCC) within one business day of admission
Communicates all medical necessity review outcomes to in-house care management staff and relevant parties as needed
Collaborates with the in-house staff and/or physician to clarify information, obtain needed documentation, present opportunities and educate regarding appropriate level of care
Collaborates with the financial clearance center, patient access, financial counselors, and/or business office regarding billing issues related to third party payers
Coordinates the P2P process with the physician or physician advisor, FCC, Revenue Cycle team when necessary and when assigned and maintains documentation relevant to the appeal process.
Quality/Revenue Integrity
Demonstrates active collaboration with other members of the health care team to achieve the outcomes management goals including CMS indicators
Accurately records data for statistical entry and submits information within required time frame
Accurately records data for statistical entry and submits information within required time frame
Documentation will reflect all work and communication related to the FCC, payor, physician, physician advisor and in-house care management
Second-level physician reviews will be sent as required and responses/actions reflected in documentation
Facilitation of Patient Care
Prioritizes patient reviews based on situational analysis, functional assessment, medical record review, and application of clinical review criteria
Collaborates with the in-house care manager Maintains rapport and communication with the in-house care manager Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assignment
Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures
Directs physician and patient communication regarding non-coverage of benefits
Maintains positive, open communication with the physicians, nurses, multidisciplinary team members and administration
Educates hospital and medical staff regarding utilization review program.
Hospital provided communication devices will be used during work hours.
Staff must be available as designated for meetings or training, onsite or online, unless prior arrangements are made
Sensitive to workload of peers and shares responsibilities, fills in and offers to help
Actively participates in departmental process improvement team; planning, implementation, and evaluation of activities
Complies with FCC and department policies and procedure, including confidentiality and patient’s rights.
Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities (i.e., medical necessity criteria, MS-DRGs, POA).
Participates in FCC and community committees as assigned.
Bachelor's Degree or equivalent experience; Specialty/Major: Nursing or related field
Current unrestricted RN license required; RN compact license preferred
Three years nursing experience in an acute care environment preferred
Utilization review/discharge planning experience preferred
Recent experience or working knowledge of medical necessity review criteria preferred
Current working knowledge of quality improvement processes
This is a remote role which requires access to high-speed internet
Excellent interpersonal, communication and negotiation skills in interactions with physicians, payors, and health care team colleagues
Commitment to exceptional customer service at all times
Communicate ideas and thoughts effectively verbally and in writing
Ability to assess and identify appropriate resources, internal and community, on assigned caseload, and to work collaboratively with health care team, providers, and payors to achieve the desired patient, quality, and financial outcomes
This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require
#LI-Remote
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
Fortune Media Best Workplaces in Healthcare 2024
Monster Top Workplace for Remote Work 2024
Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States. Applications generated from outside the United States will not be considered. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact View email address on aiapply.co equity;