Nurse Utilization & Care Coordination Manager

Brown University Health; Fall River (MA); On-site; USD 80,000 - 161,000; Full time

Job summary

Brown University Health in Fall River, MA seeks an experienced hospital-based Nurse Utilization Review/Care Management professional. You will oversee medical necessity, collaborate with physicians, and secure third-party payer approvals to ensure appropriate, high-quality patient care.

You will apply InterQual criteria, review Medicare admissions daily, and drive timely discharge planning while educating care teams on regulatory guidelines and patient options.

Qualifications

• RN licensure in RI or Nurse Licensure Compact.
• Bachelor’s degree in Nursing; Master’s degree preferred.
• CPHM certification desirable.

Responsibilities

• Apply InterQual care criteria to admissions within one business day of admission.
• Interact with team and physicians to resolve level of care discrepancies.
• Provide clinical information to third party payers to support level of care.
• Review Medicare admissions daily to ensure appropriate level of care.

Skills

Utilization review

Care management

Discharge planning

InterQual criteria

Communication

Microsoft Office

Education

Bachelor’s degree in Nursing

Master’s Degree preferred

CPHM certification desirable

Tools

Microsoft Office

Job description

Brown University Health in Fall River, MA seeks an experienced hospital-based Nurse Utilization Review/Care Management professional. You will oversee medical necessity, collaborate with physicians, and secure third-party payer approvals to ensure appropriate, high-quality patient care.

You will apply InterQual criteria, review Medicare admissions daily, and drive timely discharge planning while educating care teams on regulatory guidelines and patient options.