UM Review Nurse at Astrana Health, Inc.

Orange, California, United States -

Full Time

Start Date

Immediate

Expiry Date

31 Mar, 26

Salary

35.0

Posted On

31 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Review, Clinical Judgement, Outpatient Services, Medical Necessity Criteria, Microsoft Applications, Authorizations, Referrals, Health Insurance, Interpersonal Skills, Collaboration, Education, Training

Industry

Hospitals and Health Care

Description

UM Review Nurse Department: HS - UM Employment Type: Full Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Alice Tejeda Compensation: $31.00 - $35.00 / hour Description Astrana Health is looking for an experienced CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position will typically work M-F 8 AM - 5 PM. This is a fully remote position. 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 California MUST have experience in outpatient UM. Candidates with only case management experience are not a fit. Experience with Microsoft applications such as Word, Excel, and Outlook Experience working with authorizations, referrals, or health insurance required You’ll be Great for this Role If: Two (2) years of health plan, UM, 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 remote position. Candidates must have an active and unrestricted CA license. This position will typically work Monday - Friday from 8:00 am to 5:00 pm PST. There may be up to 1 hour of voluntary OT per day. The target pay range for this role is $30.00 - $34.00 per hour for LVNs. For RNs, the salary range is $34 - $38/hr. This salary range represents our national target range for this role. Compensation is subject to change based on experience and location (present and future). Astrana Health is proud to be an 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, 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 humanresourcesdept@astranahealth.com 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.

Responsibilities

The UM Review Nurse will complete prior authorization and retrospective reviews of various medical services. They will also refer cases to Medical Directors as needed and maintain knowledge of relevant regulations.