Utilization Review Nurse - Managed Care

Johns Hopkins Medicine; Hanover (MD); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Vision insurance

Paid time off

Paid holidays

Tuition assistance

403(b) savings plan

Health and wellness programs

Job summary

Johns Hopkins Medicine is seeking a Utilization Review Registered Nurse based in Hanover, MD. This full-time role allows you to leverage your clinical expertise to enhance member care through effective monitoring and communication. Your insights on managed care will be essential to the decision-making process.

Join a forward-thinking team advocating innovative approaches to healthcare delivery. Enjoy perks like tuition assistance, work-life balance, and comprehensive insurance benefits while working remotely.

Qualifications

• Deep understanding of managed care delivery systems and utilization management.
• Knowledge of various criteria sets (i.e. InterQual).
• Ability to negotiate and resolve conflicts with external customers.

Responsibilities

• Monitor appropriateness of care received by plan members.
• Evaluate benefits and medical criteria for service authorization.
• Communicate authorization and/or denial of covered services.

Skills

Managed care delivery systems understanding

Utilization management expertise

Negotiation and conflict resolution skills

Education

Unencumbered Registered Nurse (RN) license in Maryland

3+ years' experience as an acute care RN

1+ years' experience in Managed Care/Utilization Review

Job description

vision insurance, paid time off, paid holidays, tuition assistance, 403(b), remote work

United States, Maryland, Hanover

Requisition #: 669090

Location: Johns Hopkins Health Plans, Hanover, MD 21076

Category: Nursing

Schedule: Day Shift

Employment Type: Full Time

About this position

Work Monday - Friday, the core business hours are 8:00 AM - 5:00 PM

As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization review, and verbal/written communication skills to make a difference in our members' lives. Your in-depth knowledge of the appropriate levels of care makes you a valuable resource to our members when they are in need.

What you'll do

• Monitor the appropriateness of care received by plan members in a variety of settings
• Evaluate member benefits and medical criteria to determine authorization of services
• Communicate authorization and/or denial of covered services with all parties involved

What awaits you

• Work-life balance - This is a remote role! Candidates in the following approved states will be given priority: MD, DC, VA, PA, DE, FL
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.
• Health and wellness programs and MORE!

What you'll bring

• Understanding of managed care delivery systems and utilization management
• Knowledge and expertise in utilizing various criteria sets (i.e. InterQual)
• Ability to negotiate and resolve conflicts with external customers.
• Unencumbered Registered Nurse (RN) license in Maryland (or Compact state)
• 3+ years' experience as an acute care RN
• 1+ years' experience in Managed Care/Utilization Review is required

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home.