Utilization Review Nurse - Managed Care
Johns Hopkins Medicine
- Apply
- Save Job
- Refer a Friend
- Back
Remote
Work from Home
Share This Page- Share on Facebook
- Share on Twitter
- Share on LinkedIn
- Share via Email
Job Details
Requisition #: 676793 Location: Johns Hopkins Health Plans, Hanover, MD 21076 Category: Nursing Schedule: Day Shift Employment Type: Full TimeExcel. Empower. Advance. Shine. Belong. Explore. Flourish. Champion.
Make It Happen At Hopkins!
Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHP is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP has become a leader in provider-sponsored health plans and is poised for future growth.
About this position:
Work Monday - Friday, the core business hours are 8:00 AM - 5:00 PM
As 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
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.
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.
We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Johns Hopkins Health System and its affiliates are an Equal Opportunity 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.
Apply$40.12 - $62.19 per hour
...Sinai Hospital's Utilization Review operates as a distinct specialty service... ...line of physician advisors, nurses, and support staff who... ...maintaining or improving quality of care. Summary: Conducts... ...or trends in utilization management. Monitors potential and actual...SuggestedFull timeRemote workLIFEBRIDGE HEALTH SYSTEM
Baltimore, MD3 days ago- LifeBridge Health, Inc. seeks a Utilization Review Nurse RN to perform concurrent and retrospective reviews to ensure appropriate level of care, medical necessity, and regulatory compliance... ...collaborates with physicians, care managers, and payers to secure authorizations,...Suggested
LifeBridge Health
Baltimore, MD5 days ago - LifeBridge Health, Inc. seeks a Utilization Review Nurse RN to evaluate medical necessity, level of care, and length of stay for hospitalized and ambulatory patients. The nurse reviews clinical documentation using InterQual/MCG and payer guidelines, collaborates with physicians...Suggested
LifeBridge Health
Baltimore, MD5 days ago $2,176 per week
...Registered Nurse (RN) | Medical-Surgical Location: Baltimore, MD Agency: FlexCare... ..., allied health, and therapy talent management solutions for top healthcare facilities throughout... ...to provide the highest level of patient care possible. For clinicians, we open...SuggestedFull timeContract workImmediate startShift workNight shiftTravelNurseSource
Baltimore, MD1 day ago$6,000 per month
...this Job: MedStar Union Memorial Hospital Intermediate Care (IMC) Registered Nurse Join our Intermediate Care (IMC) team at MedStar Union... ...patients, along with individuals recovering from amputations and managing congestive heart failure (CHF). It's a great opportunity...SuggestedRelocationRelocation packageFlexible hoursMedStar Health
Baltimore, MD1 hour ago$102.61k - $197k
...day to day oversight and management of Intake Clinical... ...the role will need to utilize advanced technical knowledge... ...Claims) Retrospective Review Emergency Room Review and... ...~ Bachelor's degree in Nursing required... ...Medicaid with an MCO (Managed Care Organization) required...Relocation2 days per weekMedStar Health
Columbia, MD1 hour ago- ...previous experience in pain management and/or orthopedics are highly... ...graduated from an accredited Nurse Practitioner program with current... ...pain-related concerns; Reviewing patient's medical history:... ...lifestyle modifications and self-care strategies; Collaborate...
Priority Care Clinics
Halethorpe, MD5 days ago $26 - $42 per hour
...Join our team! We invite you to explore a nursing career with our agency that will inspire... ...development, and allow you to work while managing your lifestyle needs in a career path you... ...compassionate, energetic LPNs & RNs to help care for our home healthcare clients. We are...Hourly payWeekly payFull timeShift workEast Palestine Elementary School
Catonsville, MD2 days ago$82.22k - $123.32k
...FutureCare our Dialysis Registered Nurses are skilled in handling... ...lifestyle choices that help them to manage their disease. Proud to be the... ...a leader in managing health care across a continuum of care. We... ...and mental condition, review dialysis orders, and document...Full timeTemporary workFlexible hoursFuturecare
Windsor Mill, MD1 day ago$36 - $44 per hour
...At FutureCare our Registered Nurses are our frontline heroes and are... ...as they provide support and care for our residents. Making a difference... ...stands out as a leader in managing health care across a continuum... ..., and evaluation Review resident medical records to ensure...Flexible hoursShift workNight shiftFuturecare
Baltimore, MD1 day ago- ...Job Description\n FlexCare Nursing is seeking a travel nurse RN Telemetry for a travel nursing... ..., allied health, and therapy talent management solutions for top healthcare facilities throughout... ...to provide the highest level of patient care possible.\n \n \n \n For clinicians, we...Zero hours contractShift work
FlexCare Nursing
Baltimore, MD3 days ago $31 - $47.91 per hour
...ll deliver full-scope clinical nutrition care in an environment built to grow your career... ...medical nutrition therapy decisions, manage enteral and parenteral nutrition, and serve... ...expert alongside physicians, intensivists, nurses, pharmacists, and speech-language...Part timeInternshipLifeBridge Health
Baltimore, MD1 day ago$37.15 - $57.58 per hour
...Delivery unit delivers fast-paced, high-acuity care for antepartum, laboring, and postpartum patients, including complex cases managed in partnership with a Level III NICU. It's a collaborative OB environment for nurses who want to build strong high-risk obstetric skills...Immediate startRelocation packageLifeBridge Health
Baltimore, MD3 days ago$54 - $75 per hour
...Become a part of our caring community As a CenterWell Home Health nurse, reporting to the Clinical Manager, you will provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working with a dedicated team of physicians...Full timeTemporary workApprenticeshipCenterWell
Columbia, MD5 days ago$37.15 - $57.58 per hour
...healthcare system at LifeBridge Health‘s Northwest Hospital as a Registered Nurse on our Progressive Care Unit (PCU). The Progressive Care Unit is a cornerstone of acute patient care, managing 35+ patients with diverse needs including telemetry monitoring, complex cardiac...LIFEBRIDGE HEALTH SYSTEM
Baltimore, MD2 days ago- ...Job Description Job Summary: Provide advanced critical care nursing to adult and geriatric patients in a high-acuity ICU setting. Ensure the delivery of safe, evidence-based care while managing complex and multisystem patient conditions. Responsibilities:...Flexible hours
TactStaff
Baltimore, MD5 days ago $50 - $52 per hour
...coordination of clinically competent care including assessment,... ...policy, procedures, standards of nursing practice, state and federal... ...continents, the organization manages one of the largest vertically... ..., life sciences, biotech, utilities, and retail sectors throughout...Contract workWorldwideWork visaGlobal Technical Talent
Baltimore, MD2 days ago- ...managerial level of work in planning and coordinating the provision of nursing care for a nursing division for all shifts at a Maryland Department... ...for committing felonies, and to those who are difficult to manage in a less secure setting and who have been deemed dangerous to...All shiftsShift work
State of Maryland
Jessup, MD13 hours ago $89.07k - $162.8k
...Serves as a member of the Case Management Team and applies RN clinical... ...medical appropriateness to care coordination and discharge planning... ...case management and utilization of resources and works to achieve... ...Education Associate's degree in Nursing (ADN) required and...Temporary workRelocationMedStar Health
Baltimore, MD1 hour ago$37.15 - $57.58 per hour
...Center (ASC) Preoperative and Post Anesthesia Care Unit (PACU) provides patient-centered... ...same-day surgical procedures. The team manages the full experience from preoperative preparation... ...is preferred \n Associate's degree in Nursing or Diploma in Nursing \n Maryland...Relocation packageLifeBridge Health, Inc.
Baltimore, MD27 days ago$31.25 - $36 per hour
...FutureCare our Licensed Practical Nurses are our frontline heroes and... ...as they provide support and care for our residents. Making a difference... ...stands out as a leader in managing health care across a continuum... ...on an assigned unit Review resident medical records to ensure...Flexible hoursShift workAfternoon shiftFuturecare
Baltimore, MD4 days ago- ...45 MCP - Orangeburg - Primary Care Cook Rd Pay Rate Type Hourly Pay... ...and families to optimally manage their health care, respecting... ...medications, medical conditions, and reviews with provider as needed for... ...from an accredited Practical Nurse program with six months of patient...Hourly pay
Medical University of South Carolina
Baltimore, MD3 days ago $37 - $52 per hour
...Become a part of our caring community As a CenterWell Home Health nurse, reporting to the Clinical Manager, you will provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working with a dedicated team of physicians...Temporary workApprenticeshipCenterWell Home Health
Columbia, MD1 day ago$43 - $48 per hour
...Overview At FutureCare our Wound Care Nurses are our frontline heroes and are the heart of healthcare. Through their unwavering commitment... ...as “Best Nursing Homes”, FutureCare stands out as a leader in managing health care across a continuum of care. We are known for...Flexible hoursFuturecare
Baltimore, MD2 days ago- ...our Role The Care Management team performs and case management (CM) activities demonstrating clinical judgment and independent analysis... ...and those involved with members care including clinical nurses and treating MDs. The Care Management Nurse, Senior will report...Full timeWork at office
Blue Shield of CA
Baltimore, MD1 day ago $37 - $52 per hour
...Join Our Caring Community As a CenterWell Home Health nurse, reporting to the Clinical Manager, you will provide personalized, one-on-one care that helps patients regain independence in the comfort of their homes. Working with a dedicated team of physicians and clinicians...Temporary workCenterWell Senior Primary Care
Columbia, MD3 days ago$27.15 - $42.08 per hour
...specialized 17-bed Pulmonary Care long-term care unit where residents... ...and receive comprehensive nursing care. Many residents are... ...oriented but require assistance managing chronic and acute medical... ...Licensed Practical Nurse (LPN) utilizes nursing knowledge and assessment...Shift workLifeBridge Health
Baltimore, MD4 days ago$38 - $60 per hour
...high-quality, and compassionate resident care. Guided by our core values of Passion, Respect... ..., the RN Supervisor supports daily nursing operations, ensures regulatory compliance... ...changes in condition or care needs. Assist in managing multiple residents and prioritize care...Daily paidFull timeLocal areaShift workNight shiftWestgate Hills Rehabilitation and Healthcare Center
Baltimore, MD2 days ago$85k - $97.76k
...Home Infusion Registered Nurse This role provides high-quality home infusion nursing care, using the nursing process and critical... .... The nurse coordinates and manages all aspects of infusion... ...agree that your application may be reviewed using AI tools. ActalentPermanent employmentFlexible hours$40.12 - $62.19 per hour
Following a collaborative team model, the Nurse Navigator identifies and manages high risk patient populations, coordinates their care, and provides safe, age-appropriate patient care. Credentials Registered Nurse License BSN or higher preferred BLS Certification from...
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Nurse - Managed Care. Be the first to apply!
- remote utilization review nurse part time Hanover, MD
- behavior management Hanover, MD
- identity management Hanover, MD
- management development program Hanover, MD
- entry level asset management Hanover, MD
- junior asset management Hanover, MD
- construction management Hanover, MD
- care management associate Hanover, MD
- asset management intern Hanover, MD
- management team Hanover, MD