[Hiring] UM Review Nurse @Astrana Health, Inc.
Role Description
Astrana Health is looking for an experienced CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position will typically work M-F 8 AM - 5 PM. This is a fully remote position.
• 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 California
• MUST have experience in outpatient UM. Candidates with only case management experience are not a fit.
• Experience with Microsoft applications such as Word, Excel, and Outlook
• Experience working with authorizations, referrals, or health insurance required
Requirements
• Two (2) years of health plan, UM, IPA or MSO experience
• Strong interpersonal skills
• Ability to collaborate with co-workers, senior leadership, and other management
• Experience educating and training staff
Benefits
• The target pay range for this role is $30.00 - $34.00 per hour for LVNs. For RNs, the salary range is $34 - $38/hr.
• This salary range represents our national target range for this role. Compensation is subject to change based on experience and location (present and future).
Company Description
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need.
Apply Now
Apply Now
Astrana Health is looking for an experienced CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position will typically work M-F 8 AM - 5 PM. This is a fully remote position.
• 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 California
• MUST have experience in outpatient UM. Candidates with only case management experience are not a fit.
• Experience with Microsoft applications such as Word, Excel, and Outlook
• Experience working with authorizations, referrals, or health insurance required
Requirements
• Two (2) years of health plan, UM, IPA or MSO experience
• Strong interpersonal skills
• Ability to collaborate with co-workers, senior leadership, and other management
• Experience educating and training staff
Benefits
• The target pay range for this role is $30.00 - $34.00 per hour for LVNs. For RNs, the salary range is $34 - $38/hr.
• This salary range represents our national target range for this role. Compensation is subject to change based on experience and location (present and future).
Company Description
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need.
Apply Now
Apply Now