Brown University Health
Utilization Care Manager - St. Anne's Hospital
$80K–$161K
Saint Annes Hospital · Hybrid · Manager · Full-time · Posted Oct 28, 2026
- Experience
- Five years’ clinical experience; recent experience in utilization review, case management, patient navigation, or discharge planning is strongly preferred.
- Education
- Bachelor’s degree in Nursing; Master’s degree preferred.
About the job
Reviews hospital admissions and ongoing care for medical necessity, secures payer authorizations, and supports appropriate care levels, appeals, and patient flow.
What you'll do
- Apply InterQual™ criteria and review admissions and continued stays to confirm appropriate levels of care and identify delays.
- Coordinate with physicians, care teams, and insurers on authorizations, discrepancies, notices, and expedited appeals.
- Educate patients and staff on coverage notices, appeal rights, and care options; support timely discharge planning.
What they ask for
- Registered Nurse license in Rhode Island or under the Nurse Licensure Compact.
- Bachelor’s degree in Nursing and current RN license.
- Familiarity with InterQual™ care management criteria.
- Strong analytical and interpersonal skills; proficiency with Microsoft Office, including email and Outlook calendar.
Nice to have
- Master’s degree.
- Certified Professional in Healthcare Management (CPHM); recent experience in utilization review, case management, patient navigation, or discharge planning is strongly preferred.
Pay
$80,329.60-$160,617.60 (base salary)
Tools
InterQual™, Microsoft Office, Outlook
Model-written summary · the original posting is authoritative