Remote Utilization Review Nurse - CA Licensed

Astrana Health, Inc.; Monterey Park, Northern (CA, KY); Hybrid; USD 47,000 - 58,000; Full time

Job summary

Astrana Health, Inc. is seeking a CA-licensed Utilization Management Review Nurse to support our Health Services Department. You will apply clinical judgement to approve or deny outpatient medical services based on Medical Necessity Criteria for various Health Plans.

This is a remote role for CA-licensed nurses who live in California. The position requires at least one year of outpatient Utilization Management experience in a fast-paced environment.

Qualifications

• Active and unrestricted LVN license in CA.
• At least 1 year of outpatient UM experience.
• Experience with Microsoft 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

CA LVN license

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Astrana Health, Inc. is seeking a CA-licensed Utilization Management Review Nurse to support our Health Services Department. You will apply clinical judgement to approve or deny outpatient medical services based on Medical Necessity Criteria for various Health Plans.

This is a remote role for CA-licensed nurses who live in California. The position requires at least one year of outpatient Utilization Management experience in a fast-paced environment.