Payer Liaison for Utilization Management

Lifespan; Providence (RI); On-site; USD 84,000 - 167,000; Full time

Job summary

Brown University Health is seeking an experienced Utilization Review liaison to coordinate and monitor third-party requirements, collaborate with payers, and guide the UR program across departments. The role emphasizes accurate documentation, data reporting, and support for denials management.

Ideal candidates hold RN licensure in Rhode Island, a nursing-related degree, and 3+ years in acute care with UR experience. The position is based at Rhode Island Hospital with standard weekday hours.

Qualifications

• RN license in RI or via compact.
• Bachelor's degree in nursing or related health science.
• 3+ years in acute care; 2+ years in utilization review.
• Knowledge of UR processes and regulatory requirements.

Responsibilities

• Monitor compliance with third-party UR requirements.
• Serve as liaison with payers on patient status.
• Consult with departments and staff on UR issues.
• Coordinate UR program and educate care managers.
• Provide data reporting for HINNs and denial mitigation.
• Support policy development and committee work.

Skills

Clear communication

UR program coordination

Educate care managers

Education

Bachelor's Degree in nursing or related health science

Tools

InterQual criteria

Job description

Brown University Health is seeking an experienced Utilization Review liaison to coordinate and monitor third-party requirements, collaborate with payers, and guide the UR program across departments. The role emphasizes accurate documentation, data reporting, and support for denials management.

Ideal candidates hold RN licensure in Rhode Island, a nursing-related degree, and 3+ years in acute care with UR experience. The position is based at Rhode Island Hospital with standard weekday hours.