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Job Details

Utilization Management Specialist

Requisition #: 190281
Location: Johns Hopkins Hospital Nursing, Baltimore, MD 21201
Category: Nursing
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Aug. 2, 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 Johns Hopkins Hospital

Baltimore, MD

Under the general supervision of the UM Team Manager, this individual performs UM activities which includes admission review, concurrent review, retrospective chart review and clinical systems review to measure clinical performance and UM issues that affect reimbursement for the patient’s hospital stay or visit. Responsibilities include medical record review, providing clinical information to the payer, UM data collection and reporting, clinical team interaction, Physician Advisor interaction and special projects which are coordinated and directed by the UM Team Manager. May design and initiate special projects as supervised by the Team Manager.

  • Work requires incumbent to be a graduate of an accredited school of nursing; BSN preferred. BSN may be waived for extensive Clinical, UM, CM, or Appeals experience
  • Current Registered Nurse licensure in the state of Maryland
  • Knowledge of health care and managed care delivery systems. This includes standards of medical practice; insurance benefit structures and related legal/ medical issues
  • Utilization Management, Case Management, Disease Management or Appeals experience preferred
  • Minimum of three years of nursing experience which includes an acute care hospital setting#LI-MS1

#LI-MS1

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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