Utilization Management Specialist - Psych
Requisition #:
626222 Location:
Johns Hopkins Hospital, Baltimore, MD 21201 Category:
Nursing Schedule:
Day ShiftPart-time remote UM Specialist position.
Must have psych nursing experience.
Join an amazing global healthcare organization! Excellent compensation package! Awesome benefits, including dependent tuition reimbursement! Position
Summary:
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.
Schedule:
20 hours/week.
8 AM-4 PMEducation:
Completion of an accredited Nursing Program (RN) or LCSW required, BSN preferred.
Knowledge, Skills, and Abilities:
Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures, and basic disease processes; basic knowledge of medical records coding standards.
Analytical ability required to gather data, decide on conformity based on predetermined criteria, identify problems and refer for resolution; Ability to assess medical records and make determinations on length of stay and proper procedures in accordance with policies and procedures, with experience in assigned specialty.
Knowledge of billing practices, identification of billing problems, adequacy of documentation, and ability to conduct research of issue at hand, as well as formulate recommendations based on findings; capable of providing in-service education to health care providers in regard to this topic; awareness of licensing and accreditation standards.
Knowledge and experience with Milliman Care Guidelines/ other UM criteria.
Advanced interpersonal and communication written and verbal skills necessary to gather and exchange data (both internally and externally) with members of the health care team; prioritizes and organizes work to meet changing priorities.
Analytical ability required to gather data, uses clinical judgment to apply predetermined criteria, or uses independent clinical judgment when no predetermined criteria exists to identify problems, facilitate resolution, recommend corrective action, and report results effectively.
Independent clinical judgment in reviewing records to determine status of patients stay, if proper procedures have been followed, seriousness of incidents and ability to identify need for and participate in focused reviews, special projects and identify opportunities for improvement.
Required Licensure, Certification, On-going Training:
Valid state Nursing licensure or Social Work License for Psychiatry requiredWork
Experience:
Minimum of five years of nursing experience or five years of licensed social work experience, with preference for Utilization Management, Care Management, Appeals and/or clinical experienceImportant Notice:
Authorization to Work in the United States:
Applicants who require sponsorship now or in the future will not be considered for this position.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Important Notices:
Effective January 1st 2022, you must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of your vaccination status as part of your new employee pre-boarding.
Exceptions to the COVID-19 vaccination requirement may be granted for medical reasons and religious beliefs.
Requests for medical exceptions must be submitted at your occupational health screening.
In the wake of the COVID-19 pandemic, the Johns Hopkins Health System remains committed to providing the highest quality care for our patients and our communities.
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, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.
Apply To apply, visit jeid-84d54276a35d2d42a80334b23ae4ec9a Recommended Skills Analytical Anatomy Appeals Billing Clinical Works Corrective And Preventive Action (Capa) Estimated Salary: $20 to $28 per hour based on qualifications.
626222 Location:
Johns Hopkins Hospital, Baltimore, MD 21201 Category:
Nursing Schedule:
Day ShiftPart-time remote UM Specialist position.
Must have psych nursing experience.
Join an amazing global healthcare organization! Excellent compensation package! Awesome benefits, including dependent tuition reimbursement! Position
Summary:
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.
Schedule:
20 hours/week.
8 AM-4 PMEducation:
Completion of an accredited Nursing Program (RN) or LCSW required, BSN preferred.
Knowledge, Skills, and Abilities:
Knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures, and basic disease processes; basic knowledge of medical records coding standards.
Analytical ability required to gather data, decide on conformity based on predetermined criteria, identify problems and refer for resolution; Ability to assess medical records and make determinations on length of stay and proper procedures in accordance with policies and procedures, with experience in assigned specialty.
Knowledge of billing practices, identification of billing problems, adequacy of documentation, and ability to conduct research of issue at hand, as well as formulate recommendations based on findings; capable of providing in-service education to health care providers in regard to this topic; awareness of licensing and accreditation standards.
Knowledge and experience with Milliman Care Guidelines/ other UM criteria.
Advanced interpersonal and communication written and verbal skills necessary to gather and exchange data (both internally and externally) with members of the health care team; prioritizes and organizes work to meet changing priorities.
Analytical ability required to gather data, uses clinical judgment to apply predetermined criteria, or uses independent clinical judgment when no predetermined criteria exists to identify problems, facilitate resolution, recommend corrective action, and report results effectively.
Independent clinical judgment in reviewing records to determine status of patients stay, if proper procedures have been followed, seriousness of incidents and ability to identify need for and participate in focused reviews, special projects and identify opportunities for improvement.
Required Licensure, Certification, On-going Training:
Valid state Nursing licensure or Social Work License for Psychiatry requiredWork
Experience:
Minimum of five years of nursing experience or five years of licensed social work experience, with preference for Utilization Management, Care Management, Appeals and/or clinical experienceImportant Notice:
Authorization to Work in the United States:
Applicants who require sponsorship now or in the future will not be considered for this position.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Important Notices:
Effective January 1st 2022, you must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of your vaccination status as part of your new employee pre-boarding.
Exceptions to the COVID-19 vaccination requirement may be granted for medical reasons and religious beliefs.
Requests for medical exceptions must be submitted at your occupational health screening.
In the wake of the COVID-19 pandemic, the Johns Hopkins Health System remains committed to providing the highest quality care for our patients and our communities.
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, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.
Apply To apply, visit jeid-84d54276a35d2d42a80334b23ae4ec9a Recommended Skills Analytical Anatomy Appeals Billing Clinical Works Corrective And Preventive Action (Capa) Estimated Salary: $20 to $28 per hour based on qualifications.
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