Utilization Management Review Nurse Specialist

5 hours ago


Houston, Texas, United States Astrana Health Full time
Job Title:
Utilization Management Review Nurse

About the Role:
Astrana Health is seeking an experienced Utilization Review Nurse to work remotely from Texas. This position requires a strong understanding of state and federal regulations and accreditation standards. The ideal candidate will have excellent interpersonal skills and the ability to collaborate with co-workers, senior leadership, and other management.

Key Responsibilities:
• Complete prior authorization and retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
• Refer cases to Medical Directors as needed
• Maintain knowledge of regulatory requirements and accreditation standards
• Perform other job duties as requested

Requirements:
• Active and unrestricted LVN license in Texas
• Experience with Microsoft applications such as Word, Excel, and Outlook
• Two (2) years of health plan, IPA, or MSO experience

About Astrana Health:
Astrana Health is a physician-centric, technology-powered healthcare management company. Our mission is to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. We empower over 12,000 physicians to provide care for over 1.3 million patients nationwide.

Environmental Job Requirements:
This is a remote position. Candidates must be located in Texas. The target pay range for this role is $28 - $35 per hour.

Astrana Health is an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender, sexual orientation, gender identity, or other applicable legally protected characteristics.

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