Johns Hopkins Medicine Authorization Medical Review RN in Glen Burnie, Maryland

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Authorization Medical Review RN

Requisition #: 168964

Location: Johns Hopkins Health Care,

Glen Burnie, MD

Category: Nursing

Work Shift: Day Shift

Work Week: Full Time (40 hours)

Weekend Work Required: Yes

Date Posted: April 16, 2018

Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.

The Medical Review URN is responsible to processing authorization requests in accordance to members’ evidence of coverage (EOC), established medical criteria for medical necessity and renders a determination within his/her scope of practice. The Medical Review URN collaborates with reqesting providers and UM Medical Directors in obtaining additional information that may support the request for an authorization. The Medical Review URN applies medical criteria and medical policies in accordance to company policy, documents in accordance to company policy and guidelines within the established timeframes based on product (line of business jurisdiction) and request priority. The Medical Review URN prepares the adverse determination letter content in accordance to established company policy, guidelines and timeframes.

Requirements:

  • Current RN licensure in the State of Maryland; BSN is preferred.

  • Requires excellent analytical, organizational, oral and written and interpersonal communications skills, the ability to manage multiple tasks and priorities, the ability to independently resolve complex issues and keep management appropriately informed. Also requires good leadership skills. Work also requires reinforcing quality standards, analyzing and resolving quality and customer service problems, identifying trends and recommending process and procedural improvements, ability to handle sensitive and confidential information, and the ability to communicate and exchange information with all internal and external customers.

  • Work requires ability to communicate effectively in English both verbally and in writing. Ability to collaborate with network providers in obtaining appropriate information to facilitate care for members. Clinical review with physicians is necessary. Requires excellent interpersonal skills and attitude to effectively project a positive image of managed care programs by being courteous, helpful, friendly and professional in relationships with enrollees, families and co-workers. Work requires the ability to be self-motivated and able to work independently to assess situations and respond appropriately, to make independent decisions, have the ability to initiate and implement policies and procedures and accept change. Work requires proficient computer skills including Microsoft Office products and ability to type at a minimum 30 WPM

  • Strong familiarity and working knowledge of Microsoft office applications including advanced features

  • Work requires one (1) year of managed care/utilization review experience and demonstrated experience in the health care environment as acquired during five (4) years of acute care experience. Experience with cost containment and claims payment is a plus.

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.