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Johns Hopkins Health System
Baltimore, MD, United States
Job Summary Reports directly to the JHH VP of Care Coordination/Utilization Management and indirectly to the JHBMC Senior Director of Care Management and is responsible for the coordination, management and success of The Johns Hopkins Hospital and The Johns Hopkins Bayview Medical Center Utilization Management programs. The Director develops and i
Job Source: Johns Hopkins Health SystemDevoted Health
Nottingham, MD, United States
At Devoted Health, we're on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That's why we're gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company - one that combines compassion, health insurance, clinical care, service, and techn
Job Source: Devoted HealthAscension Health
Baltimore, MD, United States
Ascension Health Market Director of Case Management & Utilization Management Baltimore , Maryland Apply Now Schedule: Monday - Friday. 40 hours a week. Hospital: Ascension Saint Agnes Ascension Saint Agnes is seeking a dynamic and experienced Director of Case Management & Utilization Management. In this position you will play a piv
Job Source: Ascension HealthHiring Now!
Laurel, MD, United States
Details Department: Ascension Interim Leadership Travel Program Schedule: Monday - Friday, 8am-5pm, on call as needed Hospital: St. Agnes Location: Baltimore, Maryland This is an internal Interim contract for 3-6 months. Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer
Job Source: Hiring Now!Ascension
Baltimore, MD, United States
Details Department: Ascension Interim Leadership Travel Program Schedule: Monday - Friday, 8am-5pm, on call as needed Hospital: St. Agnes Location: Baltimore, Maryland This is an internal Interim contract for 3-6 months. Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer m
Job Source: AscensionUniversity of Maryland Medical System
Baltimore
Job Description Job Description Company Description Renowned as the academic flagship of the University of Maryland Medical System, our Magnet®-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together t
Job Source: University of Maryland Medical SystemAscension Health
Baltimore
**Details** + **Department:** Case Management & Utilization Management + **Schedule:** Monday - Friday. 40 hours a week. + **Hospital:** Ascension Saint Agnes + **Location:** Onsite - Baltimore, Maryland Ascension Saint Agnes is seeking a dynamic and experienced Director of Case Management & Utilization Management. In this position you will play a
Job Source: Ascension HealthSaint Agnes Hospital
baltimore
Interim RN Director Case Management and Utilization Management Details * Department: Ascension Interim Leadership Travel Program * Schedule: Monday - Friday, 8am-5pm, on call as needed * Hospital: St. Agnes * Location: Baltimore, Maryland This is an internal Interim contract for 3-6 months. Benefits Paid time off (PTO) Various health insurance
Job Source: Saint Agnes HospitalBaltimore, MD, United States
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Job Details
Requisition #: 638783
Location: Johns Hopkins Hospital,
Baltimore,
MD 21201
Category: Leadership
Schedule: Day Shift
Job Summary
Reports directly to the JHH VP of Care Coordination/Utilization Management and indirectly to the JHBMC Senior Director of Care Management and is responsible for the coordination, management and success of The Johns Hopkins Hospital and The Johns Hopkins Bayview Medical Center Utilization Management programs. The Director develops and implements UM plans for both facilities in accordance with the mission and strategic goals, federal and state law and regulations, payor requirements and accreditation standards. The Director collaborates with clinical staff and payers to ensure medically appropriate and cost-effective care, through the application of nationally recognized utilization criteria. The Director collaborates with the Senior Physician Advisor and Physician Advisors to analyze trends and take appropriate actions to reduce risk to both organizations. The Director oversees and manages departmental operations for both facilities to assure the consistent and appropriate performance of prospective, concurrent and retrospective reviews. The Director collects, analyzes and reports on data related to the utilization of medical services and resources and prioritizes performance improvement initiatives based on data analysis. The Director identifies and actively oversees performance measures and outcomes for presentation at the Utilization Review Committee for both facilities. The Director provides leadership and strategic direction to assure professional responsibility, accountability and competency in the processes of utilization management. The Director is responsible for building effective relationships across all internal departments, the Health System, relevant outside insurance companies, and outside healthcare networks. This position requires a candidate with a significant background in utilization management and broad experience with third party practice standards, State and Federal regulations, and the formal denial/appeal process.
Qualifications
Completion of an accredited Registered Nursing Program required. Bachelor's degree in Nursing, Healthcare Administration or Business Administration. Master's degree preferred.
Licensed in the State of Maryland as a Registered Nurse (RN) required
Requires demonstrated experience in utilization review and appeals acquired through 10 or more years of progressively-responsible experience such as:
10+ years clinical experience as a staff nurse, including 8 or more years clinical experience in an academic medical center with critical care experience required
5+ years of experience in a managed care or an insurance company's utilization review department
10 years of experience within hospital utilization management and experience with the formal appeals process
10 years progressive experience in a management role with multiple direct reports
Progressive Management experience, including recent experience of >5+ years in a Director role required
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.
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Email Alert for Director of Utilization Management jobs in Baltimore, MD, United States
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