Utilization Management Nurse: Authorization & Review Expert

Astiva Health, Inc.; Orange (CA); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

401(k)

Dental Insurance

Health Insurance

Life Insurance

Vision Insurance

Paid Time Off

Job summary

Astiva Health, Inc. in Orange, CA is seeking a Utilization Management Authorization Review Nurse to manage inpatient and outpatient utilization. The role involves conducting thorough reviews of clinical documentation and ensuring adherence to Care Guidelines and CMS regulations.

Candidates should have a valid LVN license and a strong background in Utilization Management, with at least 3 years in clinical nursing. The position offers various benefits including health insurance, paid time off, and a 401(k) plan.

Qualifications

• Minimum of 3 years of clinical nursing experience, focused on Utilization Management.
• Familiarity with Medicare, Medicaid, and CMS regulations.
• Strong ability to apply clinical knowledge to support medical necessity decisions.

Responsibilities

• Manage authorizations, deferrals, and denials by reviewing clinical documentation.
• Ensure timely and accurate processing of authorization requests.
• Collaborate with healthcare providers and UM teams for effective communication.

Skills

Clinical knowledge application

Utilization management experience

Excellent communication skills

Strong organizational skills

Education

Licensed Vocational Nurse (LVN)

Bachelor’s Degree in Nursing

Tools

Milliman Care Guidelines (MCG)

InterQual

Job description

Astiva Health, Inc. in Orange, CA is seeking a Utilization Management Authorization Review Nurse to manage inpatient and outpatient utilization. The role involves conducting thorough reviews of clinical documentation and ensuring adherence to Care Guidelines and CMS regulations.

Candidates should have a valid LVN license and a strong background in Utilization Management, with at least 3 years in clinical nursing. The position offers various benefits including health insurance, paid time off, and a 401(k) plan.