UM Review Nurse
About The Position
Astrana Health is seeking a California-licensed Utilization Review Nurse to support its Health Services Department. The nurse uses clinical judgment and Medical Necessity Criteria to approve or deny outpatient medical services for patients across various health plans. This is a remote position for nurses who live in California; candidates within 30 miles of the Monterey Park office may be expected to work hybrid. The role requires at least one year of outpatient Utilization Management experience in a fast-paced setting. The position typically follows business hours of Monday through Friday, 8:30 a.m. to 5 p.m., but requires open availability between 8 a.m. and 8 p.m. Pacific Time, Monday through Sunday. Nurses work five shifts per week and rotate weekend and holiday coverage. Overtime is required. The listed pay range is $34.00 to $47.00 per hour; actual compensation depends on job level, location, experience, and other job-related factors. Astrana Health describes its values as putting patients first, empowering entrepreneurial provider and care teams, operating with integrity and excellence, being innovative, and working as one team. The employer is an Equal Employment Opportunity and Affirmative Action employer and offers accommodations to applicants with disabilities upon request. The job description is not an employment agreement and may change as employer needs and job requirements change.
Requirements
- Active and unrestricted LVN or RN license in California.
- At least one year of outpatient Utilization Management experience in a fast-paced setting.
- Experience with Microsoft applications such as Word, Excel, and Outlook.
- Live in California.
Nice To Haves
- Two years of health plan, 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 and retrospective reviews of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment.
- Refer cases to Medical Directors as needed or appropriate.
- Maintain knowledge of state and federal regulations and accreditation standards.
- Comply with internal policies and procedures.
- Perform other job duties as requested.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
