UM Review Nurse
About the role
Astrana Health is seeking a CA-licensed Utilization Review Nurse to support our Health Services Department. This position involves reviewing outpatient medical services for patients based on Medical Necessity Criteria and relevant Health Plans.
Responsibilities
- Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
- Refer cases to Medical Directors as needed/appropriate
- Maintain knowledge of state and federal regulations and accreditation standards
- Comply with internal policies and procedures
- Perform any other job duties as requested
Qualifications
- Active and unrestricted LVN license in CA
- At least 1 year of outpatient Utilization Management experience
- Experience with Microsoft applications such as Word, Excel, and Outlook
Requirements
- Live in California
Skills
- Strong interpersonal skills
- Collaboration with co-workers, senior leadership, and other management
- Education and training staff
Benefits
This is a remote position. Environmental job requirements and working conditions include typical business hours of Monday - Friday from 8:30 AM to 5 PM, with open availability between 8 AM - 8 PM PST, M-Su. Schedules consist of 5 shifts per week, with weekend and holiday coverage. Overtime is required in this position.
Pay
The national target pay range for this role is $34.00 - $47.00 per hour. Actual compensation will be based on job level, geographic location (current or future), experience, and other job-related factors.
Schedule
Typical business hours are Monday - Friday from 8:30 AM to 5 PM, but this position requires open availability between 8 AM - 8 PM PST, M-Su. Schedules consist of 5 shifts per week, with weekend and holiday coverage. Overtime is required in this position.