Address
Form of workWho you are:
As the Clinical Appeals Nursing Supervisor for Johns Hopkins HealthCare, you are responsible for the daily operations of the Clinical Appeals Team. In addition, applying your clinical expertise and knowledge of our Medical Policy and InterQual criteria, you assist your team in determining the outcome of requested appeals.
What you'll do:
What you'll bring:
Who we are:
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC is a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, at Johns Hopkins HealthCare, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHC is the place to call home.
Please note: US citizenship is required for this position as it falls under the terms of a government contract (to ensure compliance with DODPSP).
This position is eligible for remote work.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. 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.
As the Clinical Appeals Nursing Supervisor for Johns Hopkins HealthCare, you are responsible for the daily operations of the Clinical Appeals Team. In addition, applying your clinical expertise and knowledge of our Medical Policy and InterQual criteria, you assist your team in determining the outcome of requested appeals.
What you'll do:
- You are responsible for the daily operations of the Clinical Appeals Team to include but not limited to:
- Training
- Auditing
- Evaluations
- Managing daily assignments
- Researching and responding to clinical questions as it relates to appeal process
- Research and Triage of appeals
- Works with all staff to ensure compliance with all applicable regulatory and accreditation standards and mandates.
- Performs internal quality improvement activities. Analyzes quality audit data to identify trends and opportunities to improve service delivery.
- You will assist the team with occasional weekend coverage as needed to support the lines of business
What you'll bring:
- 2+ years' experience in Managed Care Appeals and/or Utilization Review experience
- 5+ years' total experience which includes progressive responsibilities in the areas of supervision of staff, managed care, appeals, utilization management, quality management or claims management.
- Knowledge of health insurance standard of practice as evidenced by working in a payer environment whether case management, utilization management, appeals, or claims processing. Participation in quality improvement activities would be beneficial.
- RN license from Maryland (or Compact state) is required
Who we are:
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC is a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, at Johns Hopkins HealthCare, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHC is the place to call home.
Please note: US citizenship is required for this position as it falls under the terms of a government contract (to ensure compliance with DODPSP).
This position is eligible for remote work.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. 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.
