Remote Utilization Review Nurse

Johns Hopkins Health Plans; Maryland; On-site; USD 55,000 - 85,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

403B Savings Plan

Paid time off

Job summary

Johns Hopkins Health Plans is seeking a Utilization Review Registered Nurse to apply clinical, managed care and utilization review expertise to improve member outcomes.

This remote role supports the organization with standard hours; you will monitor care relevance, evaluate benefits, communicate authorizations or denials, and initiate discharge planning. Maryland RN license (or compact) and 3+ years acute care experience plus 1+ year UR is required.

Qualifications

• Understanding of managed care and utilization management.
• Knowledge of InterQual or similar criteria sets.
• Ability to negotiate and resolve conflicts with external customers.
• Unencumbered RN license in Maryland (or compact state).
• 3+ years’ experience as an acute care RN.
• 1+ years’ experience in Managed Care/Utilization Review.

Responsibilities

• Monitor the appropriateness of care for plan members across settings.
• Evaluate member benefits and medical criteria to grant services.
• Communicate authorizations and/or denials to involved parties.
• Initiate discharge planning for members.

Skills

Managed care

Utilization Review

InterQual

Communication skills

Education

RN license MD

Job description

Johns Hopkins Health Plans is seeking a Utilization Review Registered Nurse to apply clinical, managed care and utilization review expertise to improve member outcomes.

This remote role supports the organization with standard hours; you will monitor care relevance, evaluate benefits, communicate authorizations or denials, and initiate discharge planning. Maryland RN license (or compact) and 3+ years acute care experience plus 1+ year UR is required.