Utilization Review Team Manager

Johns Hopkins Hospital; Baltimore (MD); On-site; USD 100,000 - 125,000; Full time

Job summary

An established industry player in healthcare is seeking a Utilization Review Team Manager to lead a dedicated team of Utilization Specialists. This role is pivotal in ensuring medical necessity reviews and collaborating with healthcare delivery teams to enhance patient care. The ideal candidate will bring extensive clinical experience, regulatory knowledge, and a passion for improving healthcare outcomes. Join a supportive environment that values diversity and offers generous benefits, where your contributions can make a significant impact on patient care and the healthcare community.

Benefits

Generous Benefits

Incentives

Diverse Career Options

Qualifications

• 5+ years clinical experience as a staff nurse.
• Experience in supervisory roles managing work assignments.

Responsibilities

• Oversee Utilization Specialists in the Utilization/Clinical Resource Management department.
• Conduct admission, concurrent, and retrospective utilization reviews.

Skills

Utilization Review

Clinical Management

Regulatory Knowledge

Collaboration with Healthcare Teams

Education

Accredited Nursing Program

Bachelor of Science in Nursing (BSN)

Job description

Join to apply for the Utilization Review Team Manager role at Johns Hopkins Hospital

Requisition #: 652016

Location: Johns Hopkins Hospital, Baltimore, MD 21287

Category: Nursing Support/Patient Care

Schedule: Day Shift

Employment Type: Full Time

About Johns Hopkins Medicine

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

What You Will Do

This role involves leadership and management of the Utilization Specialists within the department of Utilization/Clinical Resource Management. The Utilization Team Manager oversees functions including:

• Admission, concurrent, and retrospective utilization review for medical necessity
• Collaboration with healthcare delivery teams
• Review of utilization outcomes and related improvement activities

The manager must have a strong background in nationally recognized screening criteria, reimbursement trends, and challenges in the acute care setting. Collaboration with Physician Advisors and leadership to identify and implement improvement projects is essential.

What Awaits You

Learn how Johns Hopkins nurses are making a difference: https://www.youtube.com/watch?v=bzFQKLJ_B-U

We offer a supportive environment with generous benefits, incentives, and diverse career options. Our workplace is recognized as one of the best in the world. Explore our benefits at https://jhhs.mybenefitsjhhs.com/

What You Will Bring

• Completion of an accredited Nursing program. BSN preferred, but extensive UM, Appeals, or Case Management experience (5+ years) may substitute.
• Minimum of five years' clinical experience as a staff nurse.
• Experience in supervisory roles managing others' work assignments.
• Knowledge of regulatory requirements related to Utilization Review and experience applying review methodologies.
• Valid Maryland Nursing License.

Salary Range: $51.22/hour - $79.39/hour, commensurate with experience and role scope. Salary discussions may occur during screening if range is not specified.

Johns Hopkins prioritizes employee health and well-being. Join us and be healthy at Hopkins!

Diversity and Inclusion

We are committed to creating a welcoming environment that embraces differences, values all employees, and promotes equitable healthcare and workforce practices. Johns Hopkins Medicine is an Equal Opportunity/Affirmative Action employer.