Utilization Review Nurse (Intrastaff)

Johns Hopkins Medical Management Corporation•Baltimore, MD

1d•$55•Remote

About The Position

Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of Johns Hopkins locations. Our employees are the strength of our service. Intrastaff is unique because it's one of the very few agencies where a person has the benefit of being a temporary employee and also feels like a member of a large organization. Working at Hopkins means joining a culturally diverse team that includes some of the best nurses, physicians, and allied health professionals in the world. Directly or indirectly, you'll have exposure to cutting-edge technology and groundbreaking medical research. Shift: Mon – Fri, 8:00am-5:00pm EST Work Location- REMOTE No call, holiday, or weekend There is no direct patient care; this is a medical review position only. $55/hr Duties: Responsible for the day-to-day management of health confined plan members in acute care and/or rehabilitative facilities. The Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, such as acute hospitals, sub-acute hospitals, and acute rehabilitation facilities. The Utilization Nurse applies member benefits and medical criteria to determine authorization of services in coordination with the Medical Directors. The Utilization Nurse proactively initiates discharge planning for members, including identification of post-discharge needs and coordination of post discharge referrals/services. The UN communicates verbally and in writing authorization and/or denial of covered services with providers, facilities, and members. The UN is a member of the administrative and clinical teams in the area of assignment. Clinical knowledge is maintained and updated, and UN must maintain acceptable documentation and quality standards. Skills: Excellent verbal and written communication skills to effectively interact and work correctly with enrollees, Physicians facility staff, and management staff. Work requires excellent interpersonal skills and an attitude to effectively project a positive image of our Managed Care Program. Computer skills working with a variety of applications and online systems. Knowledge of Enterprise and utilizing various criteria sets, i.e., InterQual. Ability to negotiate and resolve conflicts with external customers.

Requirements

Active RN License
(5) years RN experience
Current UR experience
EPIC and referral platforms such as NaviHealth or AllScripts.
Knowledge and use of Proficiency using InterQual and/or Milliman criteria software systems
Excellent verbal and written communication skills to effectively interact and work correctly with enrollees, Physicians facility staff, and management staff.
Work requires excellent interpersonal skills and an attitude to effectively project a positive image of our Managed Care Program.
Computer skills working with a variety of applications and online systems.
Knowledge of Enterprise and utilizing various criteria sets, i.e., InterQual.
Ability to negotiate and resolve conflicts with external customers.
BLS certification.

Nice To Haves

managed care experience in utilization review for at least 1 year preferred.

Responsibilities

Facilitating and coordinating programs that may include hospital inpatients, outpatients, families, community, and employees of both the hospital and the university by providing evidence-based care based on the nursing process, policies, procedures, and protocols of the Johns Hopkins Hospital.
Providing direction to/management of other team members to promote quality, safety, and excellence in care.
Working collaboratively with and providing leadership for a multidisciplinary health care team to support program initiatives that support quality, safety, and excellence in care.
Participating in promoting and identifying quality improvement initiatives (clinical, financial, operational) that support, protects and promotes area of specialty.
Initiating and participating in the research activities relevant to the specialty area.
Implementing initiatives in the area of specialty as directed by nursing and medical leadership.
Fostering a clinical environment of service excellence.
Responsible for the day-to-day management of health confined plan members in acute care and/or rehabilitative facilities.
The Utilization Nurse (UN) actively monitors the appropriateness of care received by plan members in a variety of settings, such as acute hospitals, sub-acute hospitals, and acute rehabilitation facilities.
The Utilization Nurse applies member benefits and medical criteria to determine authorization of services in coordination with the Medical Directors.
The Utilization Nurse proactively initiates discharge planning for members, including identification of post-discharge needs and coordination of post discharge referrals/services.
The UN communicates verbally and in writing authorization and/or denial of covered services with providers, facilities, and members.
The UN is a member of the administrative and clinical teams in the area of assignment.
Clinical knowledge is maintained and updated, and UN must maintain acceptable documentation and quality standards.