VP, Utilization Management

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:

By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare.

Reporting to the Chief Clinical Officer, this position is responsible for providing leadership for all activities related to the management of Virtual Utilization Review (VUR) and Bedded Insurance Authorization (BIA) functions. The VP of Utilization Management helps set the strategic direction for all Ensemble clients for the Utilization Management scope. The VP of Utilization Management is responsible for providing direction and leadership to achieve ongoing operational quality, cost management, service line productivity, identifying and implementing strategies to improve client results, regulatory compliance guidelines, and promote operational efficiency in the VUR and BIA areas while also partnering with the Physician Advisor (PA) leaders to ensure continuity and commercialization goals across the three areas that encompass Utilization Management. The VP is responsible for planning, directing and overseeing the performance of the functional areas (BIA and VUR) that report to this position including the development and maintenance of effective use of Global Talent resources, leadership and oversight of assessments, contracting and pricing strategy, and client SOWs and SLAs. The VP of Utilization Management will help organize and participate in business development activities such as: pricing discussions, ownership and gathering details for client presentation, management of vendor relationships, and other universal UM activities as assigned.

II. Job Competencies

Leadership Decision Making - Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results.

Coaching & Building Talent - Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers.

Delegation - Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.

Leading Teams - Inspires and sustains team unity and engagement by developing, motivating, and guiding the team to achieve results together through productive relationships and work.

Executive Communication - Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others’ attention (appropriate, impactful, and clear).

Program/Project Management - Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results.

III. Essential Job Functions

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.

Develops long-range strategic plans for systems and processes that support a high performing, UM revenue cycle. Provides vision, leadership and operational oversight for BIA and VUR functions and assists Senior UM leaders across PA, VUR and BIA functions to achieve overarching strategy goals. This position will establish positive, collaborative relationships with operational leaders to fulfill the Ensemble Differences. Leads initiatives to resolve problematic trends and process questions to resolve difficult account issues as needed. Develops strategies to identify root cause surrounding client issues and concerns and works with revenue cycle or onsite leadership at client site to create processes to address those issues and potential improvements.

Builds long-term staffing strategies across stateside and global talent to improve our cost profile while maintaining and delivering best-in-class quality and client results.

Maintains strong understanding of revenue cycle metrics and leads team in building plans to support operational departments to achieve best practice performance through strong analytical capabilities, process improvement identification, and technology enhancements.

Actively leads and/or participates in modernizing department service delivery. This includes but is not limited to goal setting (department level and/or overall revenue cycle), tracking and reporting of metrics, development and implementation of action plans to achieve goals, the review and implementation of new technologies, use of global resources, standardization of policies and processes and development of communication tools, both for associates and internal customers.

Organizes functions through establishing clear accountabilities, delegation of duties and appropriate departmentalization without creating silos. Develops and maintains an effective, visible and well-respected leadership team by selecting, evaluating, coaching and managing the performance of qualified professionals. Negotiates and recruits with other department managers the need for cross training and support in their areas as necessary. Promotes team-building relationships in all areas of responsibility. Works in a collaborative manner with all managers/team leaders to ensure a successful and compliant revenue cycle process.

Accountable for a comprehensive and effective communication strategy with the department that promotes Employee Engagement, which includes enhanced employee productivity and morale. Communication style should promote a common understanding of the market, vision, strategy and accountabilities. Promotes a culture of two-way communications and creates opportunities for staff participation while also ensuring a unified department voice internally and externally. Collaborates with various revenue cycle departments to obtain innovative initiatives to achieve optimal results. Determines appropriate staffing levels, monitors compensation and strengthens recruiting and retention process to meet revenue and budget objectives.

Assists with UM budget management, represents UM on new client pricing and assessments, and partners with UM leadership on the operational strategy. Works to ensure each function of the UM group (BIA, VUR, and PA) are aligned in strategy and approach and present a unified path both internally and externally.

Ensures associates are aware and compliant with all applicable laws, regulations, guidelines, etc.

IV. Employment Qualifications

Legally Required License / Certification (Ex: MD, RN, LPN, etc.) ONE CERTIFICATION PER FIELD

Ensemble Required License / Certification (Ex: CRCR) ONE CERTIFICATION PER FIELD

Certified Healthcare Access Manager (CHAM) certification, Certified Revenue Cycle Representative (CRCR) certification within 90 days of hire

Or other approved job relevant certification.

Desired Education

Bachelors Degree or Equivalent Experience

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.

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 [email protected].

This posting addresses state specific requirements to provide pay transparency.  Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position.  A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

Employment Disclaimers – Ensemble