About the job
Department: HS – UM
Location: 600 City Parkway West 10th Floor, Orange, CA 92868
Compensation: $30.00 – $34.00 / hour
Description
Astrana Health is looking for a Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position will typically work M-F 8:30 a.m. to 5 p.m, as well as every other Saturday for 4-5 hours from home. The nurses rotate holiday coverage. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.
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
- 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 be located in California.
- This position will typically work Monday – Friday from 8:00 am to 5:00 pm. 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. This salary range represents our national target range for this role.
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 [email protected] 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.