Utilization Review Manager - Remote - Faulkner

A Case Management professional at Brigham and Women's Faulkner Hospital performs essential activities including assessment, planning, and coordination to facilitate safe post-discharge transitions. The role involves conducting utilization reviews, managing audits and appeals, and collaborating with payers and physicians to ensure appropriate levels of care and reimbursement. Staff must demonstrate expertise in insurance plans, criteria sets like InterQual, and the peer-to-peer process while functioning independently in a busy environment.