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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.
Locations
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
Experience Qualifications
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
NursingRN – 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.
At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow.
As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care.
Learn about our awards (https://stanfordhealthcare.org/about-us/awards.html) and significant events (https://stanfordhealthcare.org/about-us/our-history.html) .
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