UM Review Nurse

🕒 5 days ago

🏄 California – Remote

🏄 California – Remote

💵 $34 - $47 / hour

⏰ Full Time

🟢 Junior

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Astrana Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Astrana Health is a healthcare company that operates community-focused clinics and a provider-facing technology platform to coordinate care across primary, urgent, and multi-specialty services. It supports providers and local communities by streamlining access to care, automating prior authorizations, and connecting patients with in-network clinicians. Astrana combines clinical services with doctor-built technology to improve patient experience and provider workflows.

📋 Description

• 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

🎯 Requirements

• Active and unrestricted LVN license in CA. • At least 1 years of outpatient UM experience • Experience with Microsoft applications such as Word, Excel, and Outlook • At least 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.

🏖️ Benefits

• 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. • 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.