Utilization Management Review Nurse

6 days ago

Monterey, United States Astrana Health Full time
Description

Job Title: Utilization Management Review Nurse - OPEN TO NEW GRADS

Department: Health Services

About the Role:

Astrana Health is looking for a Utilization Review Nurse to assist our Health Services Department. This position will typically work M-F from 8:30 a.m. to 5 p.m. We also require weekend and holiday coverage if there is a business need. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.

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,
  • Experience with Microsoft applications such as Word, Excel, and Outlook
You'll be Great for this Role If:
  • Two (2) 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
Who We Are

Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 12,000 physicians to provide care for over 1.3 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Environmental Job Requirements and Working Conditions:
  • This position is on a hybrid schedule. The office is located in Monterey Park.
  • The target pay range for this role is $28 - 35 per hour.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon 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 on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request 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.

#LI-Hybrid

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