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Supervisor Utilization Management

Job Details

Requisition #:
Johns Hopkins Health Plans, Hanover, MD 21076
Allied Health/Clinical Professional
Day Shift

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. 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. YOU belong here.

What awaits you:

  • Work-life balance - This is a hybrid role requiring you to work 1 day per week in the Hanover, MD office!
  • 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!

Who you are:

As the Utilization Management Supervisor for Johns Hopkins Health Plans, you are the go-to for the Utilization Management team that focuses their work on outpatient and precertification review. You are the connection between the front-line and management. You are cool under pressure and are always thinking of ways to improve our member’s experience.

What you’ll do:

  • Responsible for the day-to-day operations of the team and utilization management for all lines of business under Johns Hopkins Health Plans with a focus on outpatient and precertification review.
  • You will have direct daily interactions with all aspects of staffing to include, but not limited to, daily assignments and coverage, investigation and resolution processes.
  • In conjunction with the manager, you will support all Plan expectations including, productivity standards, continual learning, quality, and excellent member and provider service.
  • Reinforce quality standards
  • Analyze and resolve quality and customer service problems
  • Identify trends and recommend process and procedural improvements

What you’ll bring:

  • 3+ years of utilization management/review experience is required
  • 3+ years of acute care nursing experience
  • 1+ years’ management experience is required
    • Leadership in a health insurance and/or managed care setting is highly preferred
  • Knowledge of utilization management tools such as InterQual
    • Knowledge of Hayes, Tricare policies and COMAR a plus.
  • Excellent analytical, organizational, oral and written and interpersonal communications skills
  • The ability to independently resolve complex issues and keep management appropriately informed.
  • Ability to manage multiple tasks and priorities
  • Ability to handle sensitive and confidential information, and the ability to communicate and exchange information with all internal and external customers.
  • Requires a current RN licensure in the State of Maryland (or Compact state licensure)
    • BSN is preferred

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

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.

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 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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