Remote CA Utilization Review Nurse (UM)

Astrana Health Management; Monterey Park, Northern (CA, KY); Hybrid; USD 47,000 - 65,000; Full time

Job summary

Astrana Health Management in California is seeking a CA-licensed Utilization Review Nurse to support our Health Services Department. You will review outpatient services for medical necessity according to plan criteria.

This is a remote role for CA-licensed nurses; candidates must reside in California. At least 1 year of outpatient UM experience is required, with compensation in the $34-$47 per hour range depending on experience and location.

Qualifications

• Active and unrestricted LVN license in CA.
• At least 1 year of outpatient UM experience.
• Experience with Microsoft applications such as Word, Excel, and Outlook.

Responsibilities

• 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.

Skills

Outpatient UM experience

Microsoft Word

Microsoft Excel

Microsoft Outlook

Education

Active California LVN license

Job description

Astrana Health Management in California is seeking a CA-licensed Utilization Review Nurse to support our Health Services Department. You will review outpatient services for medical necessity according to plan criteria.

This is a remote role for CA-licensed nurses; candidates must reside in California. At least 1 year of outpatient UM experience is required, with compensation in the $34-$47 per hour range depending on experience and location.