Job Description:

Utilization Review Nurse (Part-Time, 12-19 hrs/wk - Saturday/Sunday)

Requisition #: 453543

Location: Johns Hopkins Health Care,

Hanover,
MD 21076


Category: Non-Clinical Professional

Work Shift: Day Shift

Work Week: Casual (less than 20)

Weekend Work Required: Yes

Date Posted: Nov. 29, 2021

Johns Hopkins HealthCare (JHHC) 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. JHHC 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. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.

POSITION SUMMARY

Responsible for the day to day management of health confined plan members in acute care and/or rehabilitative facilities. The Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, acute hospital, sub-acute hospital, and acute rehabilitation facility. The Utilization Nurse applies member benefit and medical criteria to determine authorization of services in coordination with the Medical Director. The Utilization Nurse proactively initiates discharge planning for of members, including identification of post-discharge needs and coordination of post discharge referrals/services. The UN communicates verbally and in writing authorization and/or denial of covered services with providers, facilities and members. The UN is a member of administrative and clinical teams in the area of assignment. Clinical knowledge is maintained and updated and UN must maintain acceptable documentation and quality standards.

Requirements:

Education:		Registered Nurse (RN) with active unrestricted license in the State of MD. BSN preferred.
B. Knowledge:		Knowledge of health care and managed care delivery systems. Standards of medical practice. Utilization management. Knowledge of Community resources. Senior Utilization Nurse: Proficiency using InterQual and/or Milliman criteria. Ability to analyze complex data.
C. Skills:		Excellent verbal/written communication skills to effectively interact and work collectively with enrollees, physicians, facility staff and management staff in English. Work requires excellent interpersonal skills and attitude to effectively project a positive image of managed care programs. Computer skills working with a variety of applications and online systems. Knowledge and expertise in utilizing various criteria sets, for example InterQual. Ability to negotiate and resolve conflicts with external customers.
D. Required Licensure, Certification, Etc.:		Registered Nurse (RN) with active unrestricted license in the State of MD. BSN preferred.
E. Work Experience:		Minimum of three years of acute care nursing experience. Participation in quality improvement activities. Managed care experience in utilization review of at least one year required.
F. Machines, Tools, Equipment:		Must be able to operate general office and communications equipment.

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.

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