Strategic Utilization & Care Manager

LCS Lifespan Corporate Services d/b/a Brown University Health; United States; On-site; USD 80,000 - 161,000; Full time

Job summary

Brown University Health seeks an Emergency Department Utilization Care Manager to oversee medical necessity surveillance and ensure appropriate care levels in collaboration with the physician of record and UR committee.

The role requires RN licensure and experience in utilization review and discharge planning, with strong communication to payers and care teams. On-site with schedule adherence and hospital-wide quality focus.

Qualifications

• RN licensure in RI or equivalent state required.
• Bachelor’s degree in Nursing; Master’s degree preferred.
• CPHM certification desirable.

Responsibilities

• Assess medical necessity and assign appropriate care level.
• Coordinate with physicians and UR committee for approvals.
• Communicate with third-party payers regarding authorizations.
• Deliver HINN notices when inpatient care is not medically necessary.
• Educate team on Medicare guidelines and utilization review processes.

Skills

Utilization review

Case management

Nursing

InterQual criteria

Communication skills

Microsoft Office

Education

Bachelor's degree in Nursing

Master’s Degree preferred

CPHM certification desirable

Tools

Microsoft Office

Job description

Brown University Health seeks an Emergency Department Utilization Care Manager to oversee medical necessity surveillance and ensure appropriate care levels in collaboration with the physician of record and UR committee.

The role requires RN licensure and experience in utilization review and discharge planning, with strong communication to payers and care teams. On-site with schedule adherence and hospital-wide quality focus.