RN Leader, Utilization Management & Clinical Appeals

Brown Medicine; Cranston (RI); On-site; USD 98,000 - 195,000; Full time

Job summary

Brown University Health is seeking an experienced Utilization Management leader to oversee nurses, payor liaisons and preauthorization staff at Rhode Island Hospital. You will guide the design and improvement of the utilization management model to support patient-centered care.

Unit leaders are expected to drive quality, manage resources, and supervise up to 40 FTEs on a day shift, with on-call coverage as needed. A Rhode Island RN license and nursing degree are required.

Qualifications

• Current Rhode Island RN license required.
• Bachelor’s degree in nursing; master's preferred.
• Five years of utilization management leadership experience.

Responsibilities

• Provide leadership for utilization management nurses, payor liaisons and preauthorization staff.
• Develop and implement utilization management models and policies.
• Manage budgets and resources to support standards of practice.
• Act as on-call resource for system utilization management staff.
• Lead performance improvement and quality programs.

Skills

Leadership

Communication

RN licensure

Education

Bachelor's degree in nursing

Master's degree in nursing or health discipline preferred

Job description

Brown University Health is seeking an experienced Utilization Management leader to oversee nurses, payor liaisons and preauthorization staff at Rhode Island Hospital. You will guide the design and improvement of the utilization management model to support patient-centered care.

Unit leaders are expected to drive quality, manage resources, and supervise up to 40 FTEs on a day shift, with on-call coverage as needed. A Rhode Island RN license and nursing degree are required.