UM Review Nurse LVN
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Job Location:
Monterey Park, NM - USA
Hourly Salary:
$ 34 - 47
Posted on:
17 hours ago
Vacancies:
1 Vacancy
Job Summary
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services 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 requires open availability between Monday through Sunday 8 A - 8 P. You would be scheduled for 5 shifts per week. This is a remote position for CA-licensed nurses. Candidates must live in California.
We are seeking nurses with at least one year of outpatient UM experience in a fast-paced setting.
Our Values:
This position requires open availability between Monday through Sunday 8 A - 8 P. You would be scheduled for 5 shifts per week. This is a remote position for CA-licensed nurses. Candidates must live in California.
We are seeking nurses with at least one year of outpatient UM experience in a fast-paced setting.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What Youll 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 CA.
- 1 years of outpatient UM experience
- Experience with Microsoft applications such as Word Excel and Outlook
Youll 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 remote position. Our office is located at 1600 Corporate Center Drive in Monterey Park CA. Candidates who live within a 30 mile radius of the office may be expected to work hybrid.
- 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 national target pay range for this role is $34.00 - $47.00 per hour. Actual compensation will be based on job level geographic location (current or future) experience and other job-related factors.
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 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.
Required Experience:
IC
