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Utilization Management Review Nurse
2 months ago
Astrana Health is seeking a skilled Utilization Management Review Nurse to join our Health Services Department. This hybrid role combines in-office and remote work, with a typical Monday-to-Friday schedule from 8:30 a.m. to 5 p.m. Weekend and holiday coverage may be required based on business needs.
Key Responsibilities- Conduct prior authorization and retrospective reviews of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
- Refer cases to Medical Directors as necessary
- Stay up-to-date on state and federal regulations, as well as accreditation standards
- Ensure compliance with internal policies and procedures
- Perform other job duties as assigned
- Active and unrestricted LVN license in California, Nevada, or Texas
- Experience with Microsoft applications, including Word, Excel, and Outlook
- Two (2) years of experience in health plan, IPA, or MSO settings
- Strong interpersonal skills and ability to collaborate with colleagues and senior leadership
- Experience educating and training staff
Astrana Health is a physician-centric, technology-powered healthcare management company. Our mission is to provide high-quality, cost-effective care to patients nationwide. We empower over 12,000 physicians to deliver end-to-end care to over 1.3 million patients. Our platform combines clinical expertise, best-in-class delivery networks, and technological innovation to improve patient outcomes and increase access to quality healthcare.
Environmental Job Requirements- This position is a hybrid role, with a mix of in-office and remote work
- 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, age, or other protected characteristics. All employment decisions are based on qualifications, merit, and business need. If you require accommodation due to a disability, please contact us at [email address].
