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Utilization Review Nurse

2 months ago


Columbia, Maryland, United States Johns Hopkins Medicine Full time
Position Overview

The Utilization Review Nurse plays a critical role in ensuring the quality and efficiency of patient care. This position is integral to the Utilization Management team, reporting directly to the Manager of Utilization Management.

Key Responsibilities
  • Conduct thorough reviews of medical records to assess utilization and quality of care.
  • Engage in effective communication with third-party payors regarding reimbursement issues.
  • Handle initial denials from payors and participate in special projects as directed by the UR Payor Management Team Leader.
  • Design and implement special initiatives under the supervision of the Manager of Utilization Management.
Qualifications
  1. Must be a graduate of an accredited nursing program.
  2. A Bachelor of Science in Nursing (BSN) is mandatory.
  3. At least three years of relevant clinical experience is required, with a preference for experience in discharge planning, utilization, and quality management.
  4. Experience in multiple clinical areas is advantageous.
Why Choose Us?

At Johns Hopkins Medicine, we pride ourselves on fostering a supportive and collaborative work environment. Our team enjoys:

  • A collegial atmosphere that promotes teamwork.
  • A nursing student loan repayment program.
  • Comprehensive benefits, including free parking.

Commitment to Diversity: We value diversity and inclusion as core principles, striving to create a welcoming environment where all employees feel valued and contribute to our mission of equitable healthcare delivery.

Equal Opportunity Employer: We are committed to fair employment practices and welcome applicants from all backgrounds.