Conduct medical necessity reviews and continued stay reviews using approved clinical criteria to support quality and financial outcomes.
Collaborate with liaisons, physicians, and revenue cycle teams to manage denials, appeals, and appropriate levels of care.
Maintain documentation, monitor utilization trends, and facilitate patient care planning across the care team.
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They empower associates to challenge the status quo and put people first, fostering a collaborative and innovative culture.
Lead and mentor Nurse Practitioners and clinical teams in a remote telehealth environment.
Oversee clinical operations, quality assurance, and regulatory compliance.
Drive strategic initiatives to improve patient access and care delivery.
The company operates a remote telehealth-focused clinical environment, delivering personalized, data-driven, and preventive healthcare. It fosters a collaborative culture with clinical and administrative leadership, offering professional growth opportunities.
Oversee system-level utilization management activities across the organization.
Ensure compliance with medical necessity criteria such as InterQual and Milliman.
Manage professional staff and review processes to optimize patient care.
Piedmont Healthcare is a healthcare system providing comprehensive medical services. It is a large organization focused on utilization management and quality care.