Job Overview
Location
Remote - USA
Job Type
Full-time
Category
Software Engineering
Date Posted
May 7, 2026
Full Job Description
đź“‹ Description
- • The Utilization Management Registered Nurse (UM RN) ensures efficient and effective use of healthcare resources while promoting quality patient care, playing an essential role in the financial health of Stanford Health Care by navigating the complexities of patient care and resource utilization.
- • Day to day, the UM RN performs timely comprehensive utilization reviews on patient medical records, evaluates treatment plans and progress notes for compliance, identifies opportunities for improved resource utilization and cost containment, collaborates with healthcare teams to ensure continuity of care, facilitates communication among providers, patients, and payers, maintains accurate documentation, generates reports on utilization metrics, educates staff on UM principles, and works closely with Physician Advisors on complex cases, denials, and appeals.
- • Stanford Health Care is a leader in healthcare innovation and patient-centered care, committed to excellence in clinical outcomes, financial stewardship, and an exceptional patient experience through its C-I-CARE standards, which emphasize knowing the patient, showing them the way, and coordinating their care.
- • In this role, the UM RN will develop deep expertise in utilization management, payer contracts, regulatory compliance, and clinical appeals; contribute to process improvement and cost containment; enhance communication and collaboration skills across multidisciplinary teams; and advance their career in clinical leadership and healthcare operations within a prestigious academic medical center.
🎯 Requirements
- • Bachelor’s Degree in Nursing from an accredited college or university
- • Three (3) years of progressively responsible and directly related work experience
- • Solid understanding of transitions of care guidelines and utilization management principles
- • Experience in case management, utilization review, or related healthcare roles
- • Strong clinical assessment and critical thinking skills
- • Excellent communication, collaboration, and interpersonal skills
- • Proficiency in utilizing electronic health record (EHR) systems and other healthcare software
- • Nursing RN - State Licensure and/or Compact State Licensure required
- • Case Management Certification (CCM) or Utilization Management Certificate within 2 years of hire
🏖️ Benefits
- • Remote work opportunity within the USA
- • Competitive base pay scale ranging from $79.21 to $104.97 per hour
- • Opportunity to work with Physician Advisors and multidisciplinary teams on complex clinical and financial cases
- • Exposure to denial management, appeals processes, and revenue cycle operations
- • Chance to contribute to process improvement, quality assurance, and cost containment initiatives
- • Access to ongoing education and training in clinical guidelines, payer policies, and regulatory requirements
- • Role in educating healthcare professionals on utilization management and documentation best practices
- • Alignment with Stanford Health Care’s mission of innovation, patient-centered care, and organizational excellence
Skills & Technologies
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About Stanford Health Care
Stanford Health Care is an academic medical center operating as the adult hospital and clinics of Stanford Medicine, affiliated with Stanford University. It delivers tertiary and quaternary inpatient care, outpatient specialty services, and advanced procedures, integrating clinical practice with Stanford University School of Medicine research and education. Services span cancer, cardiovascular, neurosciences, organ transplantation, and surgical specialties. Facilities include Stanford Hospital and Hoover Pavilion in Palo Alto, California, serving regional and national patient populations while training medical professionals and conducting translational research.
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