Strategic Payor Liaison for Utilization Management

Brown Medicine; Cranston (RI); On-site; USD 84,000 - 167,000; Full time

Job summary

Brown University Health is seeking a utilization review liaison under general direction of department site manager. The role supports third-party payers and coordinates utilization review activities with UR staff, considering aging and cultural factors.

The position emphasizes adherence to InterQual criteria, data reporting, and denial mitigation. You will work with care managers, physicians, and departments to ensure appropriate care status and timely reimbursement.

Qualifications

• RN licensure in Rhode Island or eligible for licensure in RI.
• Bachelor’s Degree in nursing or related health science is required.
• Three years or more of relevant clinical/administrative experience; UR experience preferred.

Responsibilities

• Monitors and ensures compliance with third-party requirements related to utilization review.
• Serves as liaison with third-party payers regarding patient status.
• Provides input to director on goals, policies, and standards for UR.
• Coordinates and monitors the Medicare Hospital Issued Notices of Non-coverage (HINNs).
• Conducts retrospective reviews and audits of hospital records to determine level of care.

Education

Bachelor’s Degree in nursing or related health science

Job description

Brown University Health is seeking a utilization review liaison under general direction of department site manager. The role supports third-party payers and coordinates utilization review activities with UR staff, considering aging and cultural factors.

The position emphasizes adherence to InterQual criteria, data reporting, and denial mitigation. You will work with care managers, physicians, and departments to ensure appropriate care status and timely reimbursement.