Title: Sr. Virtual Utilization Review Specialist Location: Oregon and Alaska Remote Full time Job Description: Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. 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. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: - Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. - Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. - Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results. The Opportunity: CAREER OPPORTUNITY OFFERING: - Bonus Incentives - Paid Certifications - Tuition Reimbursement - Comprehensive Benefits - Career Advancement This position pays: - RN pay scale $39.40 - $53/hrbased on experience - LPN pay scale $32.65 - $46.90/hrbased on experience Must have current unrestricted LPN or RN compact licensure and willing to obtain single state licensure in Oregon and Alaska​. We are seeking Senior Virtual Utilization Review Specialists in Pacific Time and Mountain Time to join our team. The schedules we are offering include: Weekday work schedule: - Three - 12 hour shifts per week with rotating weekends and holidays - Training will be Monday - Friday, 8 hour shifts Essential job function include: Resource Utilization - Utilizes proactive triggers (diagnoses, cost criteria, and complications) to identify potential over/under utilization of services - 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 Denial Management - 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. - Maintains appropriate information on file to minimize denial rate - Assist in recording denial updates; overturned days and monitor and report denial trends that are noted - Monitor for readmissions 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 - Responsible for ConnectCare and ADT work queues assigned to VUR for revenue cycle workflow - 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 Communication - 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. - Maintains a calm, rational, professional demeanor when dealing with others, even in situations involving conflict or crisis - Voicemail, Skype, and email will be utilized and answered in timely fashion. Hospital provided communication devices will be used during work hours. - Staff is expected to respond and/or acknowledge communication from the FCC via approved communication guidelines and standardized service-line agreements - Staff must be available as designated for meetings or training, onsite or online, unless prior arrangements are made Team Affirmation - Works collaboratively with peers to achieve departmental goals in daily work as evidenced by appropriate and timely communication which is respectful and clear. 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 - Provides back-up support to other departmental staff as needed Other Job Functions - 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). - Actively participates in departmental meetings and activities. - Participates in FCC and community committees as assigned. - Actively participates in conferences, committees, and task forces as directed by the FCC division. - Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation. Experience: - Bachelor's Degree or equivalent experience; Specialty/Major: Nursing or related field - Must have current unrestricted LPN or RN compact licensure and willing to obtain single state licensure in Oregon and Alaska​ - 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 Other Knowledge, Skills, and Abilities Required: - 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 - Strong clinical assessment, organization and problem-solving skills - 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 - Ability to prioritize, organize information, and complete multiple tasks effectively in a fast-paced environment - Resourceful and able to work independently - Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences - 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-LS1 #LI-Remote Join an award-winning company Five-time winner of “Best in KLAS” 2020-2022, 2024-2025 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 Energage Top Workplaces USA 2022-2024 Fortune Media Best Workplaces in Healthcare 2024 Monster Top Workplace for Remote Work 2024 Great Place to Work certified 2023-2024 - Innovation - Work-Life Flexibility - Leadership - Purpose + Values Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include: - 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. - Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation. - Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement. - Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company. Ensemble is an equal employment opportunity employer. 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. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.

Role Description We are looking for a passionate and driven Associate Medical Writer to join our team and grow their career in medical communications. This will be a fully remote opportunity. If you have a strong scientific foundation and a hunger to learn, this is your opportunity to build expertise across diverse therapeutic areas while collaborating with global stakeholders and key opinion leaders. Cactus Life Sciences is a remote-first organization, and we embrace an acceleration from anywhere culture. We are actively seeking candidates who can make themselves available to onboard within the next 2–3 weeks. Responsibilities - Use scientific expertise to develop high-quality, client-ready scientific, medical, and educational materials like slides, abstracts, posters, manuscripts, MSL/training slide decks, infographics, congress and meetings materials, literature searches and reviews, standard response letters/medical information letters, and HCP engagement content according to client needs with excellent attention to detail under the guidance of the scientific leads. - Liaise and build trusting and professional relationships with international pharmaceutical clients, healthcare professionals, internal and external stakeholders including authors, reviewers, and key opinion leaders across therapeutic areas - learning to anticipate their needs. - Effectively and proactively communicate with team members, authors/faculty, clients, and vendors. - Attend workshops/seminars/trainings to hone your skills and contribute to organizational objectives. - Attend client and other external meetings and support senior team members as needed. - Apply your scientific and creative knowledge and work closely with client directors in developing ideas and executing effective medical communications initiatives in the digital space, including publication extenders, creation of infographics, interactive assets, website content, patient narratives, and medical information engagement plans. - Ensure all materials follow/comply with client requirements/SOPs, style guides, client templates, client preferences (as applicable), and CACTUS’ internal SOPs. - Perform as a document specialist, provide intellectual input across document types, and contribute to making cutting-edge research accessible to specific audiences as appropriate, by maintaining current awareness of developments across therapeutic areas or disciplines. - Share best practices and client preferences, thereby contributing to skill development within the medical communications team. Qualifications - PhD or Postdoctoral researcher in Life Sciences or Medicine; a strong scientific research background is a must. - Good understanding of clinical research and medical communications. - Clear, concise, scientific style of writing, with a high level of attention to detail and excellent language skills. - Ability to adapt writing style to different materials and target audiences. - Ability to work as part of a team or independently within a dynamic matrix environment. - Basic knowledge of biostatistics. - Literature reviewing and evaluation capabilities. - Very good working knowledge of MS Office. Application Process Before applying, please ensure you meet the role requirements listed above and have legal authorization to work in the country where this role is advertised. Our selection process typically involves an initial screening by a recruiter, a technical assessment, and two to three interview rounds. Equal Opportunity Our hiring practices reflect our commitment to providing equal opportunities and creating an environment where everyone can thrive, develop, and succeed. We celebrate the uniqueness of our team members and prohibit discrimination of any kind, based on race, color, religion, gender identity, sexual orientation, age, marital status, disability, or any other protected characteristic.

Role Description Reporting to the Senior Director of Clinical Audit, the Clinical Compliance Auditor II is an advanced-level compliance professional responsible for conducting comprehensive clinical audits of clinical documentation, regulatory compliance practices, and reimbursement related processes related to Skilled Nursing Facilities and related post‑acute care settings. This position will promote strong, compliant, and values‑aligned culture. The role ensures adherence to federal, state, and local regulations including CMS requirements, supports quality improvement initiatives, and promotes accurate clinical documentation and billing practices. - Complete internal audits related to billing and reimbursement accuracy, documentation integrity, therapy utilization and coding, quality and clinical documentation. - Analyze audit findings to identify trends and root causes. - Partner with operations and clinical operations to implement corrective action plans and ensure timely follow-up. - Conduct and or partner on compliance investigations, ensuring completed timely, objectively and well documented. - Deliver live and virtual training sessions in collaboration with operations and clinical operations. - Cross functional collaboration across the organization, including (but not limited to) operations, clinical operations, finance, HR and IT teams. - Provide regular updates on investigation and audit results and prepare reports. Qualifications - Active License in Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), or Nursing (RN) or related clinical discipline. - A bachelor’s degree, required. Master’s degree, preferred. - 5+ years of increasing levels of responsibility in compliance and/or skilled nursing facilities, specifically with behavioral health auditing. - A deep understanding and application of Medicare and Medicaid documentation, coding and regulations. - AAPC, AHIMA or HCCA Coding certification and or Auditing/Compliance certification (CPC, CCS, CCS‑P, COC, CPMA, CHC) preferred. RAC-CT preferred. - Prior experience conducting audits and or conducting internal investigations, in a healthcare setting. - Ensures compliance with regulations and controls by examining and analyzing records, reports, operating practices, and documentation; recommends opportunities to strengthen the internal control structure. - Demonstrated regional and/or compliance oversight experience supporting multiple healthcare sites. - Strong analytical capabilities, excellent communication, attention to detail, and ability to work in a dynamic, fast-paced setting. Requirements - Ability to carry out responsibilities with minimal supervision. - Apply advanced knowledge and understanding of concepts, principles, and technical capabilities to manage audits and investigations. - Possesses strong attention to detail. - Ability to effectively prioritize and execute tasks in a fast‑paced, dynamic environment. - Excellent time management, personal integrity and ability to maintain confidentiality. Physical Demands - Primarily sedentary role with extended periods of computer work. - Occasional standing, walking, and light lifting (up to 10-20 lbs). - Regular use of hands for typing and office equipment. - Ability to read and review detailed documents. - Clear verbal and written communication required. - Occasional travel based on business needs. Work location This role is remote, requiring less than 25% travel. Pay Range $90,000 - $120,000 annually depending on experience Benefits - Health Coverage: Enjoy medical, dental, and vision plans to keep you and your family healthy. - PTO and Vacation: Benefit from generous paid time off and holidays to relax and recharge. - Financial Wellness: Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively. - Retirement Planning: Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings. - Support When You Need It: Our Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.

Role Description The Clinical Documentation Specialist is responsible for the quality review of all OASIS documents and review of key elements of the Plan of Care to ensure CMS program compliance is met. The Clinical Documentation Specialist works closely with the Manager of Quality Improvement and Home Health leadership to promote regulatory compliance and excellent patient outcomes and reimbursement. The Clinical Documentation Specialist serves as a role model and OASIS expert to Home Health staff across the region. This is a remote position. Work schedule M-F 8am to 5pm PST, with a rotating schedule on weekends and holidays. Position Specific Responsibilities - Works in a virtual team environment in a manner that promotes team cohesiveness, efficiency, and productivity. - Responsible for the timely review and processing of Start of Care, Resumption of Care, Recertification, and Significant change in Condition Home Health OASIS Assessment documents and key elements of the Plan of Care. - Collaborates with leadership to analyze performance trends in OASIS accuracy; assists in determining learning needs for clinical staff. - Educates and provides feedback to clinical staff in regard to correct completion of OASIS documents. - Reviews all OASIS data items and ensures accuracy of OASIS based outcome measures to reflect accurate Home Health Quality of Care Star rating and Value Based Purchasing OASIS Based component of TPS. - Ensures Regulatory compliance with all OASIS conventions. - Ensures timely processing of all OASIS documents to meet CMS guidelines and CMS billing requirements. Qualifications - Ability to align work schedule with Pacific Time Zone business hours. - Education to meet certification, license or registration requirement. - 2 years Clinical Experience as a Registered Nurse. - 1 year Home Health Clinical Experience as an RN. - 1 year demonstrated proficiency in Home Health OASIS Review including all types of OASIS. - 1 year Experience with an Electronic Medical Record (EMR) system. - Preferred - OASIS Certification. - Preferred - Experience using Homecare Homebase (HCHB) EMR. Requirements - Must be a licensed Registered Nurse in the state of California. Compensation Compensation range: $80,000 - $90,000. The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Benefits - Comprehensive benefits package including Medical, Dental, Vision, 401k and much more. Company Description At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. The Compassus Advantage - Meaningful Work: Make an impact every day by honoring the quality of life of our patients, supporting them and their families with compassion, and creating moments that truly matter. - Career Development: Access leadership pathways, mentorship, and personalized professional development. - Innovation Meets Compassion: Collaborate with a supportive team using the latest tools and technologies to deliver exceptional care. - Enhanced Benefits: Enjoy competitive pay, flexible time off, tuition reimbursement, and wellness programs designed for your well-being. - Recognition and Support: Be celebrated for your contributions through recognition programs that honor your dedication. - A Culture of Belonging: Thrive in a culture where you can be your authentic self, valued for your unique contributions and supported in a community that embraces diversity and inclusion. Ready to Join? At Compassus, your career is more than a job—it’s an opportunity to make a lasting impact. Take the next step and join a team that empowers you to grow, innovate, and thrive.