Remote Nurse Supervisor – Utilization Mgmt

Stanford Health Care

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1.0 FTE   Full time   Day – 08 Hour   R2334082   Remote   86242 PI-POPULATION HEALTH-HPO   Nursing   180 El Camino Real,PALO ALTO,California

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Day – 08 Hour (United States of America)This is a Stanford Health Care job.

A Brief Overview
Under the supervision of the Senior Director of Accountable Care Management, the Supervisor-Nursing Utilization Management works collaboratively with the UM Nurse Manager to proactively ensure that the overall goals of the UM department are met by managing the day to day operations associated with referral intake, UM staff performance, collaboration with internal and external stakeholders and compliance with regulatory standards and/or internal policies and procedures.

Stanford Health Care

What you will do

  • Supervisory Duties
  • Ensures UM operational compliance
  • Direct supervision of non-clinical staff including: hiring, determining workload and delegating assignments, training, monitoring and evaluating performance, and initiating corrective and/or disciplinary actions.
  • Monitor and review quality/production reports of all UM staff involved with day to day referral inventory, Prior Authorization review, Concurrent review and Retro review to ensure regulatory processing timeframes are consistently met; identify and conduct additional training needed to ensure compliance with department quality/production standards. Provide performance feedback for all UM staff, as well as identify developmental opportunities for individual and team performance improvement.
  • Works with Compliance to develop policies and procedures related to UM operations and ensures coordination across departments while maintaining compliance with federal and state regulations.
  • Facilitates inter-departmental collaboration and assists with identification and resolution of issues related to UM decision- making involving the Medical Director, Provider Network Management, Eligibility, Claims or Care Counsel/Customer Services
  • Assists with the identification and submission of potential quality of care issues.
  • Workflow Improvement
  • Collaborates with Customer Service and Claims Operations to ensure interdepartmental workflows remain effective.
  • Provides direct interface with Health Plan Oversight Auditors as needed and provides oversight to the preparation of routine Health Plan reports.
  • Accountable for the development, review and testing of authorization rules within Affinity Systems.
  • Coordinate timely responses and resolutions to member appeals and grievances.
  • Identify current reference sources for ongoing clinical operations issues and provide routine staff development forums.
  • All other duties as assigned including department-specific functions and responsibilities (1, 2):
  • Performs other duties as assigned and participates in organization projects as assigned.
  • Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.

Education Qualifications

  • Bachelor’s Degree Preferred

Experience Qualifications

  • • 5+ years to 7 years direct UM work experience in an IPA or health plan setting Required • 2+ years to 3 years of experience in a Lead or Supervisory position, in a managed care environment Required • Working knowledge of UM regulatory requirements for Medicare (CMS), NCQA and Plan/IPA delegation contracts and/or Division of Financial Responsibilities (DOFRs). Required • Lean management practices Preferred

Required Knowledge, Skills and Abilities

  • Strong verbal/written communication and listening skills; including excellent interpersonal skills and telephone communication.
  • Legible handwriting.
  • Ability to maintain composure during challenging interpersonal interactions.
  • Basic computer skills.
  • Knowledge of health plan benefits.
  • Ability to effectively organize and prioritize tasks in order to complete assignments within the time allotted and maintains standard workflow.
  • Ability to work with others in a flexible, cooperative manner.

Licenses and Certifications

  • LVN – Licensed Voc Nurse preferred . or
  • Nursing\RN – Registered Nurse – State Licensure And/Or Compact State Licensure preferred .

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

  • Know Me: Anticipate my needs and status to deliver effective care
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $41.25 – $53.63 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

Saving Lives and Changing the Future of Medicine

Stanford is a part of the top 10 highest ranked Level 1 Trauma Magnet Facilities in the U.S. Combining clinical care, research, and education, our team provides compassionate, coordinated and personalized care for the unique needs of every patient. As the only Level I trauma center between San Francisco and San Jose, Stanford Health Care delivers clinical innovation across its inpatient services, specialty health centers, physician offices, virtual care offerings and health plan programs. With a state-of-the-art hospital, more than 2,800 medical staff and more than 1,300 residents and fellows, Stanford Health Care is committed to making a lasting impact through research, education and clinical care.


Stanford offers exceptional benefits and competitive pay to ensure our staff feels supported in and outside of their work. Specific roles are eligible for shift differential pay, sign-on/relocation bonus, etc. For more information, please visit our Total Rewards page!