Utilization Review Team Manager

The John Hopkins Health System; Baltimore (MD); On-site; USD 100,000 - 125,000; Full time

Job summary

An established industry player in healthcare seeks a dedicated Utilization Team Manager to lead a team of Utilization Specialists. This role involves overseeing Utilization Management functions, ensuring compliance with regulatory requirements, and collaborating with healthcare professionals to improve patient care. The ideal candidate will have extensive clinical experience, strong leadership skills, and a commitment to quality improvement. Join a renowned organization recognized for its workplace excellence and contribute to impactful healthcare delivery while enjoying generous benefits and career development opportunities.

Benefits

Dependent Tuition

Health and Wellness Programs

Perks and Discounts

Qualifications

• 5+ years of clinical experience as a staff nurse required.
• Experience in Utilization Review methodology and supervisory roles.

Responsibilities

• Manage Utilization Specialists and oversee Utilization Management functions.
• Collaborate with healthcare delivery teams and improve utilization outcomes.

Skills

Utilization Review Methodology

Clinical Experience

Supervisory Skills

Regulatory Agency Requirements

Education

Bachelor of Science in Nursing (BSN)

Accredited Nursing Program

Job description

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.