UM Review Nurse - Hybrid

Department: HS - UM

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

Compensation: $30.00 - $34.00 / hour

Description

Astrana Health is looking for a Utilization Review Nurse to assist our Health Services Department in reviewing referral/authorization requests and ensuring patients meet medical necessity criteria. This position will work M-F from 8:30 a.m. to 5 p.m, as well as rotating weekends. Candidates must be available to work 365 days a year to account for the rotating weekend and holiday coverage schedule. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.

We are open to hiring nurses without previous UM experience! If you are interested in breaking into the world of administrative nursing and pride yourself on being a quick learner/thrive in fast-paced environments, we encourage you to apply!



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

You’ll be Great for this Role If:

• Two (2) years of health plan, IPA or MSO experience
• Prior experience working in referral coordination
• 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 position operates on a hybrid schedule. The office is located at 1600 Corporate Center Drive in Monterey Park.
• The training for this position will be fully onsite for the first month, then hybrid thereafter (2-3 days a week in-office, rest of week from home).
• The target pay range for this role is $30 - 34 per hour.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon 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 on the basis of 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 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.