PRN Utilization Review Nurse

1 month ago


Baltimore, Maryland, United States Johns Hopkins Medicine Full time

You deserve more

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider-sponsored health plans and is poised for future growth.

This is a PRN position for an experienced UR RN with MCO experience.

Note: The training for this position is 6-8 weeks (remote). You will work 19 hours per week with at least one day on the weekend.

As a PRN Utilization Review Registered Nurse you will be responsible for:

  • All admissions assigned to your individual bin
  • Monitoring of assigned department bin(s)
  • Providing updates to the Medical Director at specified times
  • Checking the on call mailbox as assigned bu the Inpatient UM Supervisor in the Friday emails

What you will bring:

  • Unencumbered Registered Nurse (RN) license in Maryland (or Compact RN licensure as applicable)
  • 3+ years' experience in Managed Care/Utilization Review in MCO is required
  • 3+ years' experience as an acute care RN
  • BSN is preferred

Preferred knowledge and skills:

  • Understanding of managed care delivery systems and utilization management
  • Excellent verbal/written communication skills to effectively interact and work collectively with enrollees, physicians, facility staff and management staff
  • Knowledge and expertise in utilizing various criteria sets (i.e. InterQual)
  • Ability to negotiate and resolve conflicts with external customers.

Important Notice: Authorization to Work in the United States: Applicants who require sponsorship now or in the future will not be considered for this position.

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



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