Utilization Review Nurse – Managed Care, Multistate
665345 Excel. Empower. Advance. Shine. Belong. Explore. Flourish. Champion. Make It Happen At Hopkins! Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHP is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP has become a leader in provider-sponsored health plans and is poised for future growth. 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
- Initiate discharge planning of members
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. Apply tot his job Apply To this Job