UM Review Nurse - Texas

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

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

Compensation: $30 - $34 / year

Department: HS - UM

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

Compensation: $30 - $34 / year

Description

Astrana Health is looking for a Utilization Review Nurse with a Texas LVN license to assist our Health Services Department in reviewing a high volume of outpatient and inpatient cases. This position will require open availability from 8:00 AM to 8:00 PM Monday through Sunday. The position will rotate weekend and holiday coverage amongst the team.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• 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

Qualifications

• Active and unrestricted LVN license in Texas. Compact license preferred.
• 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 and Working Conditions

• This is a fully remote position. Nurses must be licensed in the state of Texas.
• Typical business hours are Monday - Friday from 8:30 AM to 5 PM, however, this position requires open availability between 8 AM - 8 PM PST, M-Su. Your schedule will be compromised of 5 shifts per week. Nurses rotate weekend and holiday coverage. Overtime is required in this position.
• The position will operate in PST during the 3 month probationary period. After successful completion of probationary period, position can transition to CST.
• The target pay range for this role is $30.00 - $40.00 per hour. This salary range represents our national target range for this role.

Astrana Health is proud to be an Equal Employment Opportunity and Affidavit 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, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [e-mail] to request an accommodation.

Additional Information:

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