Utilization Review Team Manager

Johns Hopkins Medicine; Baltimore (MD); Remote; USD 100,000 - 125,000; Full time

Job summary

An established industry player in healthcare is seeking a Utilization Team Manager to lead a dedicated team in optimizing patient care. This role involves overseeing Utilization Management functions, ensuring compliance with regulatory standards, and collaborating with clinical teams to enhance service delivery. The ideal candidate will bring extensive clinical experience, strong leadership skills, and a commitment to improving healthcare outcomes. Join a workplace recognized for its dedication to employee well-being and diversity, where your contributions will make a significant impact on patient care and community health.

Benefits

Generous Benefits

Health and Wellness Programs

Dependent Tuition

Career Options

Qualifications

• Minimum of five years' clinical experience as a staff nurse.
• Prior supervisory experience managing others' work assignments.

Responsibilities

• Oversee Utilization Management functions including admission and review.
• Collaborate with health care delivery teams for improvement opportunities.

Skills

Utilization Management

Clinical Experience

Supervisory Skills

Regulatory Compliance

Education

Accredited Nursing Program

BSN Preferred

Job description

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Job Details

Requisition #:

652016

Location:

Johns Hopkins Hospital,
Baltimore,
MD 21287

Category:

Nursing Support/Patient Care

Schedule:

Day Shift

Employment Type:

Full Time

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.

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