UM Review Nurse - LVN

Astrana Health; Monterey Park (CA); On-site; 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

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Compensation: $30.00 - $34.00 / hour

Department: Health Services (HS - UM)

Job Title

Utilization Management Review Nurse

About the Role

Astrana Health is looking for a Utilization Review Nurse to assist our Health Services Department. This hybrid position requires availability Monday–Sunday from 8:00 AM to 8:00 PM, including weekends and holidays as needed.

What You’ll Do

• Complete prior authorization/retrospective reviews of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment.
• Refer cases to Medical Directors as needed or appropriate.
• Maintain knowledge of state and federal regulations and accreditation standards.
• Comply with internal policies and procedures.
• Perform any other job duties as requested.

Qualifications

• Active, unrestricted LVN license in California.
• Experience with Microsoft applications such as Word, Excel, and Outlook.

You’ll be Great for this Role If

• 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.

Environmental Job Requirements & Working Conditions

• Hybrid schedule; office located at 1600 Corporate Center Drive, Monterey Park, CA.
• Typical business hours Monday–Friday 8:30 AM–5 PM; open availability 8 AM–8 PM PST, Monday–Sunday; five shifts per week with weekend and holiday coverage.
• Overtime required.
• Target pay range $30.00–$34.00 per hour; actual compensation based on location, experience, and job factors.

Equal Employment Opportunity

Astrana Health is a proud Equal Employment Opportunity and affirmative action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, veteran status, disability status, or any other legally protected characteristic. All employment is decided based on qualifications, merit, and business need. If you require assistance applying due to a disability, please email [e-mail] for accommodation.

Additional Information

The job description does not constitute an employment agreement and is subject to change by the employer as needs and requirements evolve.