RN Utilization Management (Per Diem)

Company: Johns Hopkins University
Location: Baltimore
Posted on: January 27, 2023

Job Description:

RN Utilization Management (Per Diem)

Requisition #: 601283
Location: Johns Hopkins All Children's Hospital, St. Petersburg, FL 33701
Category: Nursing
Work Shift: Day Shift
Work Week: Casual (less than 20)
Weekend Work Required: Yes
Date Posted: Jan. 19, 2023

POSITION SUMMARY:

The purpose of the RN-Utilization Management position is to collaborate with various internal and external stakeholders to advocate for the patient and ensure high quality, cost-effective care. Contributes to the goals of the department by examining appropriateness of status and level of care for the patient's clinical condition, improving coordination of care across the continuum, and aiding in optimization of financial performance to allow for continued reinvestment in JHACH. Uses clinical findings, Interqual evidence based criteria and JHACH policies/practices to perform utilization reviews for admissions, continued stays, and adverse determinations following escalation process defined in the JHACH UM Plan.

KEY ACCOUNTABILITIES:

• Reviews assigned patients for appropriateness of admission status, level of care for patient's clinical condition following compliance with accreditation standards and regulatory requirements to provide cost effective and highest quality of clinical outcomes.
• Documents utilization reviews and payor contact communication and provides timely clinical information to payor entities to support authorization.
• Ensures proper authorization requirements are met for timely reimbursement.
• Communicates payer issues and medical necessity concerns with healthcare team to provide appropriate care in the appropriate setting.
• Evaluates effectiveness of patient care plan balanced with patient's self-determination in decision making and assists with healthcare team's understanding and respect for patient's choice and goals to modify care plan as needed.
• Evaluates and facilitates concurrent denial, appeal, or payment issues until resolved to ensure proper reimbursement is received.
• Participates with providers and healthcare team in various settings such as unit huddles, walking rounds, or via phone to ensure proper documentation to support medical necessity for hospital stay is included in the electronic medical record.
  
  Work Hours: 12 hours per week
  
  Location: St. Petersburg, FL
  
  QUALIFICATIONS:
  
  
  • Current Florida RN licensure
  • Bachelor of Science in Nursing (BSN)
  • 2 years of pediatric acute hospital experience required. Case Management and/or Utilization Management experience preferred.
  • Excellent critical thinking, decision-making and problem-solving skills
  • Excellent interpersonal and communication skills with the ability to work with diverse individuals
  • Writing and computer skills to include accurate typing skills, proficiency in Windows, Microsoft word, Outlook, and Excel, electronic medical record, and other clinical platforms Works well under pressure and manage stress effectively
  • Strong working knowledge of healthcare financial systems
    Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law. Johns Hopkins Health System and its affiliates are drug-free workplace employers.
    
    We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts - including while at lunch or on breaks, and whether they are on or off campus.
    
    To apply, visit https://jobs.hopkinsmedicine.org/job/rn-utilization-management-per-diem-nursing-johns-hopkins-all-childre-601283-631e0/
    
    
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Keywords: Johns Hopkins University, Baltimore , RN Utilization Management (Per Diem), Healthcare , Baltimore, Maryland