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Job Details

Utilization Management Specialist

Requisition #: 281224
Location: Johns Hopkins Hospital Nursing, Baltimore, MD 21201
Category: Nursing
Work Shift: Day Shift
Work Week: Full Time
Weekend Work Required: No
Date Posted: Dec. 14, 2020

The Johns Hopkins Hospital 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.

Shifts: 8 hour day shift

Qualifications:

  • 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
  • Active Maryland or Compact RN license is required
  • 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 required
  • Minimum of three years of nursing experience which includes an acute care hospital setting

Join The Johns Hopkins Hospital Nursing team and become part of a patient centered collaborative work environment at a world renowned, Magnet designated, academic medical facility. Our nurses are committed to patient safety, clinical excellence, optimizing outcomes through evidenced based practice, and life-long learning.

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

We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts — including while at lunch or on breaks, and whether they are on or off campus.

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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