APPEALS NURSE ANALYST

Johns Hopkins Health Plans; Washington (District of Columbia); On-site; USD 55,000 - 84,000; Full time

Job summary

Johns Hopkins Health Plans is seeking an RN to review and resolve clinical appeals across all lines of business. You will communicate determinations in line with regulatory requirements and act as a clinical resource for staff handling denials and coding-related appeals.

The role requires RN licensure in Maryland, a BSN preferred, and at least three years of acute care nursing experience, with payer experience strongly preferred. Familiarity with quality improvement initiatives is a plus.

Qualifications

• RN license in Maryland is required.
• BSN preferred.
• Minimum three years of acute care nursing experience.
• Experience in health insurance payer environment preferred.
• Experience with quality improvement initiatives is a plus.

Responsibilities

• Review and resolve clinical appeals submitted by providers and members across all lines of business.
• Communicate appeal determinations in accordance with regulatory requirements.
• Support non-clinical staff with administrative denials and coding-related appeals.
• Maintain accurate tracking of appeals through logs, databases, and reporting tools.

Skills

Clinical appeals

Regulatory compliance

Health payer experience

Quality improvement collaboration

Education

BSN preferred

RN license in MD

Tools

Reporting tools

Job description

Requisition #:680804 Location:Johns Hopkins Health Plans, Hanover, MD 21076 Category:Nursing Schedule:Day Shift Employment Type:Full Time

Position Summary

Responsible for the timely review and resolution of clinical appeals submitted by providers and members across all lines of business. Communicates appeal determinations in accordance with regulatory requirements and serves as a clinical resource to support non-clinical staff with administrative denials and coding-related appeals. Maintains accurate tracking of appeals through logs, databases, and reporting tools.

Education

Graduate of an accredited school of nursing required; BSN preferred.

Licensure/Certification

Current Registered Nurse (RN) license in the State of Maryland required.

Experience

Minimum of three (3) years of acute care nursing experience required. Prior experience within a health insurance or payer environment strongly preferred, including case management, utilization management, appeals, or claims processing. Experience participating in quality improvement initiatives is a plus.

Salary Range

Minimum 39.64/hour - Maximum 61.45/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.