UM Review Nurse - Texas
About The Position
Astrana Health is seeking a Utilization Review Nurse with an active Texas LVN license to support the Health Services Department by reviewing a high volume of outpatient and inpatient cases. This is a fully remote position, and nurses must be licensed in Texas. The role requires open availability between 8:00 AM and 8:00 PM Pacific Time, Monday through Sunday, with five shifts per week. Weekend and holiday coverage rotates among the team. During the three-month probationary period, the position operates on Pacific Time; after successful completion, it may transition to Central Time. Overtime is required. The position performs prior authorization and retrospective reviews, refers appropriate cases to Medical Directors, maintains knowledge of applicable regulations and accreditation standards, and follows internal policies and procedures. The target pay range is $30.00–$40.00 per hour and represents the national target range for the role. Astrana Health identifies 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 job description is not an employment agreement and may change as employer needs and job requirements change.
Requirements
- Active and unrestricted LVN license in Texas.
- Experience with Microsoft applications such as Word, Excel, and Outlook.
- Overtime is required.
- Must be licensed in Texas.
Nice To Haves
- Compact license preferred.
- 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.
- Work five shifts per week with open availability between 8:00 AM and 8:00 PM Pacific Time, Monday through Sunday.
- Rotate weekend and holiday coverage with the team.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
