UM Review Nurse

Astrana Health, Inc. • Orange, CA

2d • $31 - $35 • Remote

About The Position

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. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team

Requirements

• 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

Nice To Haves

• 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

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

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees