Job Description
Description Job Title: Utilization Management Review Nurse
Department: Health Services - UM
About the Role: Astrana Health is looking for an experienced Utilization Review Nurse who will work remote, based out of Texas. This position will typically work M-F from 8:30 a.m. to 5 p.m. We also require weekend and holiday coverage if there is a business need.
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 Texas
- 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
- Strong interpersonal skills
- Ability to collaborate with co-workers, senior leadership, and other management
- Experience educating and training staff
Who We Are Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 12,000 physicians to provide care for over 1.3 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Environmental Job Requirements and Working Conditions: - This is a remote position. Candidates must be located in Texas.
- The target pay range for this role is $28 - $35 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.
Job Tags
Hourly pay, Holiday work, Weekend work,