Utilization Review Team Manager (652016)

Johns Hopkins Medicine; Baltimore (MD); On-site; 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 ensuring effective utilization management. This role involves overseeing admission reviews, collaborating with healthcare professionals, and implementing improvement projects. The organization prides itself on its commitment to community care and offers a supportive work environment recognized as one of the best workplaces globally. If you have a strong clinical background and leadership experience, this is your chance to make a significant impact in a dynamic healthcare setting.

Benefits

Generous benefits

Career options

Inclusive environment

Recognition as a top workplace

Qualifications

• Completion of an accredited Nursing program; BSN preferred.
• Minimum of five years' clinical experience as a staff nurse.

Responsibilities

• Oversee Utilization Management functions including admission and utilization review.
• Collaborate with health care delivery team and identify improvement opportunities.

Skills

Utilization Management

Clinical Experience

Supervisory Skills

Nursing

Regulatory Compliance

Education

Accredited Nursing Program

Bachelor of Science in Nursing (BSN)

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:

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.

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.

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 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.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.