Remote CA Utilization Review Nurse

Astrana Health; United States; Remote; USD 47,000 - 65,000; Full time

Job summary

Astrana Health is seeking a CA-licensed Utilization Review Nurse to support our Health Services Department. You will review outpatient services for medical necessity and approve or deny based on plan criteria, applying clinical judgement.

This is a remote position for CA-licensed nurses with residency in California. Candidates require at least one year of outpatient utilization management experience in a fast-paced setting and must be available for a 5-shift weekly schedule, including some

Qualifications

• Active and unrestricted CA RN or LVN license.
• Experience in outpatient utilization management or health plans.
• Proficient with Microsoft Office applications.

Responsibilities

• Complete prior authorization/retrospective review of outpatient services.
• Refer cases to Medical Directors as needed.
• Maintain knowledge of state and federal regulations and accreditation standards.
• Comply with internal policies and procedures.
• Perform other duties as requested.

Skills

Interpersonal skills

Collaboration

Staff training

Utilization review

Microsoft Word/Excel/Outlook

Education

CA RN or LVN license

Tools

Word

Excel

Outlook

Job description

Astrana Health is seeking a CA-licensed Utilization Review Nurse to support our Health Services Department. You will review outpatient services for medical necessity and approve or deny based on plan criteria, applying clinical judgement.

This is a remote position for CA-licensed nurses with residency in California. Candidates require at least one year of outpatient utilization management experience in a fast-paced setting and must be available for a 5-shift weekly schedule, including some