Manager, Utilization Management & Clinical Appeals

LCS Lifespan Corporate Services d/b/a Brown University Health; Rhode Island; On-site; USD 98,000 - 195,000; Full time

Job summary

Brown University Health seeks an experienced leader to head Utilization Management, guiding nurses, payor liaisons and preauthorization staff. You will shape UM policy, drive quality, and ensure efficient resource use within Rhode Island Hospital.

Requirements include RI RN licensure, a BSN (MSN preferred), and 5+ years in UM with leadership capabilities. The role is full-time, on-site, daytime hours in Providence, RI.

Qualifications

• Current Rhode Island RN license required.
• Bachelor’s degree in nursing is mandatory.
• Master’s degree in nursing or health discipline preferred.
• Knowledge of Nurse Practice Act in Rhode Island.
• Case management certification preferred.

Responsibilities

• Provide leadership for utilization management nurses, payor liaisons and preauthorization staff.
• Participate in staff interviews, selection and evaluation.
• Develop measurements for staff competencies and orientation.
• Manage budgets and resources for utilization management.
• Serve as on-call resource for UM nurses on weekends/holidays.

Skills

Leadership

Utilization management

Staff development

Interdepartmental collaboration

Education

Bachelor’s degree in nursing

Master’s degree in nursing

RN licensure RI

Nurse Practice Act knowledge

Case management certification (preferred)

Job description

Brown University Health seeks an experienced leader to head Utilization Management, guiding nurses, payor liaisons and preauthorization staff. You will shape UM policy, drive quality, and ensure efficient resource use within Rhode Island Hospital.

Requirements include RI RN licensure, a BSN (MSN preferred), and 5+ years in UM with leadership capabilities. The role is full-time, on-site, daytime hours in Providence, RI.