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Job Details

Lead Utilization Review Nurse

Requisition #: 182829
Location: Howard County General Hospital, Columbia, MD 21044
Category: Nursing
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: July 1, 2019

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

The Lead Utilization Review (UR) Nurse is responsible for supervision and oversight of the utilization management department and serves as an expert clinical reviewer. As a team leader, the Lead UR Nurse provides daily management of personnel issues and staffing for at least 30% of their time. Under the direction of the Manager, Utilization Management serves as a coach and advisor to staff, a resource, a preceptor to new employees, a reviewer of clinical quality through audits, and follows through on quality improvement initiatives utilizing lean methodology. The Lead UR Nurse also performs utilization review and payer management activities, which include prospective and/or retrospective chart and clinical systems, review to measure UR issues that affect reimbursement for the patient's hospital stay or visit. Responsibilities include medical record review, communication with third party payers, and third party payer initial denials. May design and initiate special projects as supervised by Manager, Utilization Management.

40 hours per week

8:30 AM -5:00 PM

Columbia, MD

5 years of related experience required

Bachelors Degree required

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

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. 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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