Remote Utilization Review Nurse — TX LVN

Astrana Health, Inc.; Monterey (TX); Remote; USD 41,000 - 55,000; Full time

Job summary

Astrana Health is seeking a Utilization Review Nurse with a Texas LVN license for a fully remote role in the Health Services Department. You will review outpatient and inpatient cases, with open availability from 8:00 AM to 8:00 PM, Monday through Sunday.

Weekend and holiday coverage rotate among the team. The position requires staying up-to-date with state and federal regulations, completing prior authorizations, and referring complex cases to Medical Directors as needed.

Qualifications

• Active and unrestricted LVN license in Texas. Compact license preferred.
• Experience with Microsoft applications such as Word, Excel, and Outlook.
• Two (2) years of health plan, IPA or MSO experience
• Strong interpersonal skills
• Ability to collaborate with co-workers, senior leadership, and other management
• Experience educating and training staff

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

LVN license

Microsoft Word

Microsoft Excel

Microsoft Outlook

Health plan / IPA / MSO experience

Strong interpersonal skills

Team collaboration with leadership

Staff training / education

Tools

Word

Excel

Outlook

Job description

Astrana Health is seeking a Utilization Review Nurse with a Texas LVN license for a fully remote role in the Health Services Department. You will review outpatient and inpatient cases, with open availability from 8:00 AM to 8:00 PM, Monday through Sunday.

Weekend and holiday coverage rotate among the team. The position requires staying up-to-date with state and federal regulations, completing prior authorizations, and referring complex cases to Medical Directors as needed.