Utilization Management Specialist

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Make it happen at HOPKINS.

Sibley Memorial Hospital in Washington, D.C., a member of Johns Hopkins Medicine, has a distinguished history of serving the community. As a not-for-profit, full-service, 318-bed community hospital, Sibley offers medical, surgical, obstetric, oncology and orthopedic treatment, intensive care, skilled nursing inpatient services and a state-of-the-art 24-hour emergency department. Sibley's campus is also home to Johns Hopkins Kimmel Cancer Center and The Johns Hopkins National Proton Therapy Center.

What you will do:

The UM Specialist performs Utilization Management activities which includes admission review, concurrent review, retrospective chart review and clinical systems review to measure clinical performance and Utilization Management issues that affect reimbursement for the patient's hospital stay or visit. Conducts medical record review; provides clinical information to the payer; collects and reports Utilization Management data; interacts with clinical team, Physician Advisor; and engages in special projects.

Why work at Sibley:

Click or copy and paste the link below to hear how Sibley is committed to our patients in the community.

https://www.youtube.com/watch?v=p-GP7NVU7XE

Our comprehensive benefits package is designed to help you balance work with life so you can focus on what matters most-your well-being and that of your loved ones. Some of our benefits include:

• Dependent Child Tuition Assistance
• Free onsite parking
• Two retirement plans: Retirement Income Plan and 403(b) Savings Plan
• Affordable Healthcare options
• Up to 26 days paid leave
• Tuition Reimbursement
• Supportive Nurse Leadership/Magnet Designation

What you will bring:

1. Licensed to practice as a Registered Nurse in Washington, DC. Graduate of an accredited Nursing program.
2. Bachelor's Degree or an equivalent combination of education and experience.
3. Minimum of 2-5 years clinical experience in acute care setting along with one or more years of Case Coordination experience performing discharge or transition planning from the inpatient or skilled facility setting. One or more years' experience conducting inpatient utilization management highly preferred. Preferred experience applying industry standard criteria (e.g., InterQual and M&R).
4. Current CPR certification required.

Salary Range: Minimum 41.99/hour - Maximum 65.08/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.

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.