RN - Utilization Review Managed Care - Washington
1 day ago

Job description
Requisition #:663165 Location:
Johns Hopkins Health Plans, Hanover, MD 21076 Category:
Nursing Schedule:
Day Shift Employment Type:
Full Time
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 DoMonitor 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.
Salary Range:
Minimum 38.49/hour - Maximum 59.66/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.
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 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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