Hybrid Utilization Review Nurse | Prior Authorization

Astrana Health; Monterey Park (CA); Hybrid; USD 41,328 - 46,838; Full time

Job summary

A health services company is seeking a Utilization Management Review Nurse in Monterey Park, CA. This hybrid role includes conducting reviews for inpatient admissions and outpatient procedures, ensuring compliance with regulations, and working collaboratively with the team. Candidates must have an active LVN license in California, experience in health plans, and strong interpersonal skills. Compensation ranges from $30.00 to $34.00 per hour with weekend and holiday coverage as needed.

Qualifications

• Active LVN license required for California.
• Proficiency in Microsoft Office applications is essential.

Responsibilities

• Conduct prior authorization and retrospective reviews.
• Refer cases to Medical Directors as appropriate.
• Stay informed on regulations and accreditation standards.
• Adhere to internal policies and procedures.

Skills

Microsoft applications (Word, Excel, Outlook)

Interpersonal skills

Collaboration with management

Education

Active, unrestricted LVN license in California

Job description

A health services company is seeking a Utilization Management Review Nurse in Monterey Park, CA. This hybrid role includes conducting reviews for inpatient admissions and outpatient procedures, ensuring compliance with regulations, and working collaboratively with the team. Candidates must have an active LVN license in California, experience in health plans, and strong interpersonal skills. Compensation ranges from $30.00 to $34.00 per hour with weekend and holiday coverage as needed.