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Case Management Payor Liaison - Rhode Island Hospital/Hasbro Children's Hospital (Providence, RI)

Under general direction of department director, functions as affiliate-specific liaison for utilization review with third-party payers. Participates in the coordination of the utilization review process and activities with case management staff. Must have current experience with InterQual utilization criteria. CPHM certification prefered. Must have current licensure to practice as a Registered Nurse in the State of Rhode Island or in another state that participates in the Nurse Licensure Compact. Bachelor's Degree in Nursing, Health Science or Health Business required. EXPERIENCE : Three years or more of relevant recent clinical and/or administrative experience in medical/surgical nursing; two years of which must be related to utilization review activities, demonstrating organizational skills and ability to make sound clinical judgment. Working knowledge of level of care criteria is required. Knowledge of state and federal regulations is desirable. Job Overview Work Schedule Mon-Fri 8:00-4:30 Shift Days Post Date 2013-08-29 Source:

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