About this position:Work Monday - Friday, the core business hours are 8:00 AM - 5:00 PMAs a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization review, and verbal/written communication skills to make a difference in our members' lives. Your in-depth knowledge of the appropriate levels of care makes you a valuable resource to our members when they are in need.
What you'll do:- Monitor the appropriateness of care received by plan members in a variety of settings
- Evaluate member benefits and medical criteria to determine authorization of services
- Communicate authorization and/or denial of covered services with all parties involved
- Initiate discharge planning of members
What awaits you:- Work-life balance - This is a remote role! Candidates in the following approved states will be given priority: MD, DC, VA, PA, DE, FL
- 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!
What you'll bring:- Understanding of managed care delivery systems and utilization management
- Knowledge and expertise in utilizing various criteria sets (i.e. InterQual)
- Ability to negotiate and resolve conflicts with external customers.
- Unencumbered Registered Nurse (RN) license in Maryland (or Compact state)
- 3+ years' experience as an acute care RN
- 1+ years' experience in Managed Care/Utilization Review is required
Salary Range: Minimum 39.64/hour - Maximum 61.45/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
The Hospital reserves the right to modify employee schedules as needed.
