RN Utilization Review Team Manager

Johns Hopkins Hospital; Baltimore (MD); Hybrid; Full time

Job summary

Join a renowned healthcare institution as an RN Utilization Review Team Manager. This role involves management of Utilization Specialists, overseeing crucial Utilization Management functions, and contributing to patient care improvements. A supportive environment with generous benefits awaits you at Johns Hopkins Hospital.

Benefits

Generous benefits

Incentives

Career options

Health and wellness programs

Tuition assistance

Qualifications

• Must possess a valid Maryland Nursing License.
• Requires minimum of five years' clinical experience as a staff nurse.
• Requires demonstrated experience in applying Utilization Review methodology.

Responsibilities

• Oversee Utilization Management functions including admission, concurrent and retrospective utilization review.
• Collaborate with healthcare delivery team on improvement activities.
• Manage Utilization Specialists in the department.

Skills

Utilization Review

Leadership

Clinical Management

Decision Making

Education

Completing an accredited Nursing program

BSN preferred

5+ years extensive UM, Appeals, Case Management experience

Job description

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Requisition #:652016 Location:Johns Hopkins Hospital, Baltimore, MD 21287 Category:Nursing Support/Patient Care Schedule:Day Shift Employment Type:Full Time

This position is eligible for remote work, if you live in one of the following states: Maryland, Virginia, Pennsylvania, Florida, or Washington DC.

Johns Hopkins Medicine, a nonprofit, combines over 125 years of commitment to community care with groundbreaking research, teaching and medical services to patients worldwide. Johns Hopkins Medicine operates six academic and community hospitals, four health care and surgery centers, more than six ambulatory surgery centers and has more than 2.8 million outpatient encounters per year.

What You Will Do

This position is responsible for providing leadership and management of the Utilization Specialists in the department of Utilization/Clinical Resource Management. The Utilization Team Manager oversees Utilization Management functions, which includes: admission, concurrent and retrospective utilization review for medical necessity, collaboration and participation with the health care delivery team, review of utilization outcomes and related improvement activities. The Utilization Team Manager must possess a strong background in nationally recognized screening criteria as well as an understanding of reimbursement trends and challenges in the acute care environment. The Utilization Team Manager will collaborate with the Utilization Management Physician Advisors and the leadership group to identify opportunities for improvement, including the initiation and implementation of special projects.

What Awaits You

Click or copy and paste this link to learn how Johns Hopkins nurses are making a difference. https://www.youtube.com/watch?v=bzFQKLJ_B-U

In addition to working with some of the best and brightest in the medical field, we offer our employees generous benefits, incentives and numerous career options. You can enjoy an environment that is continually recognized as one of the best workplaces in the world.

Click on the link below to explore our amazing benefits including dependent tuition, health and wellness programs, and perks and discounts.

https://jhhs.mybenefitsjhhs.com/

What You Will Bring

• Completion of an accredited Nursing program. BSN preferred but will accept extensive UM, Appeals, Case Management experience of 5 or more years in lieu of BSN degree.
• Requires minimum of five years' clinical experience as staff nurse. Prior experience in a supervisory role with accountability to manage others’ work assignments.
• Requires experience commensurate with latest regulatory agency requirements pertaining to Utilization Review; demonstrated experience in applying Utilization Review methodology.
• Valid Maryland Nursing License required.
  
  

Salary Range: Minimum 51.22/hour - Maximum 79.39/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.

JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins!

Diversity and Inclusion are Johns Hopkins Medicine Core Values. 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 / Affirmative Action 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.

Apply

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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