Utilization Management Specialist

Make it happen at Hopkins. This is a remote position. Our organization is registered for remote work in the following states: MD, VA, DC, FL, and PA. Shift: Day Johns Hopkins Medicine, a nonprofit, combines over 125 years of commitment to community care with groundbreaking research, teaching and medical services to patients worldwide. Johns Hopkins Medicine operates six academic and community hospitals, four health care and surgery centers, more than six ambulatory surgery centers and has more than 2.8 million outpatient encounters per year. What You Will Do: Under the general supervision of the UM Team Manager, the Utilization Management Specialist 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 requested by the Team Manager. Who Should Apply: Completion of an accredited Nursing Program (RN) or LCSW required, BSN preferred. Minimum of five years of nursing experience or five years of licensed social work experience, with preference for Utilization Management, Care Management, Appeals and/or clinical experience. Valid state Nursing licensure or Social Work License for Psychiatry required. What Awaits You: We’re proud to offer a robust benefits package that supports your health, growth, and well-being. Discover our full offerings and costs here: mybenefitsjhhs.com Competitive pay and benefits that support you at every stage of your life and career. Retirement plans with employer contributions to help you plan confidently for the future. Generous time off so you can unplug, recharge, and enjoy life outside of work. Access to world‑class facilities and innovative technology that fuel your curiosity. Endless opportunities to advance your career as part of the Johns Hopkins team. Salary Range: Minimum 43.61/hour - Maximum 67.59/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. #J-18808-Ljbffr