Utilization & Care Coordination Nurse (RN)

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

Job summary

Brown University Health in Fall River, MA seeks an experienced Utilization Review Nurse to monitor medical necessity and ensure appropriate admission levels. You will collaborate with physicians, payers, and the care team to secure authorizations and optimize resources.

The role requires RN licensure and at least five years of related clinical experience, with knowledge of InterQual criteria and Medicare guidelines. The position is on-site at Saint Annes Hospital with standard hours.

Qualifications

• Five years' clinical experience with utilization review, case management, discharge planning or related area.
• RN licensure in Rhode Island or Nursing Compact equivalent (per minimum qualifications).
• Strong analytical and interpersonal skills; ability to communicate with healthcare professionals, patients and families.

Responsibilities

• Apply InterQual level of care criteria to admissions within one business day.
• Review all admissions and support third party payer authorizations.
• Conduct concurrent reviews at least every three days to facilitate patient throughput.
• Provide education to care teams on Medicare and regulatory guidelines.

Skills

Analytical skills

Interpersonal skills

Collaborative communication

Education

Bachelor's degree in Nursing

Master's degree preferred

Tools

Microsoft Office

Job description

Brown University Health in Fall River, MA seeks an experienced Utilization Review Nurse to monitor medical necessity and ensure appropriate admission levels. You will collaborate with physicians, payers, and the care team to secure authorizations and optimize resources.

The role requires RN licensure and at least five years of related clinical experience, with knowledge of InterQual criteria and Medicare guidelines. The position is on-site at Saint Annes Hospital with standard hours.