UM Review Nurse

apartment Astrana Health location_onOrange, CA 92868, US

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$31 - $35 / HOUR

Apply Now

UM Review Nurse

Department: HS - UM

Employment Type: Full Time

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Reporting To: Alice Tejeda

Compensation: $31.00 - $35.00 / hour

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.

Our Values:

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

What You'll Do

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

You’ll be Great for this Role If:

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

Environmental Job Requirements and Working Conditions

This is a remote position. Candidates must have an active and unrestricted CA license.
This position will typically work Monday - Friday from 8:00 am to 5:00 pm PST. There may be up to 1 hour of voluntary OT per day.
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).

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. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information:

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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