Utilization Management Review Nurse - Hybrid
$58,240 - $72,800/Yr
Astrana Health - Monterey Park, CA
posted about 2 months ago
Full-time - Mid Level
Hybrid - Monterey Park, CA
About the position
Astrana Health is seeking a Utilization Management Review Nurse to support the Health Services Department. This hybrid role involves both in-office and remote work, primarily during weekdays, with potential weekend and holiday coverage as needed. The nurse will be responsible for conducting prior authorization and retrospective reviews, ensuring compliance with regulations, and collaborating with medical directors and staff.
Responsibilities
- 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 California.
- Experience with Microsoft applications such as Word, Excel, and Outlook.
- Two (2) years of health plan, IPA or MSO experience.
Nice-to-haves
- Strong interpersonal skills.
- Ability to collaborate with co-workers, senior leadership, and other management.
- Experience educating and training staff.
Benefits
- Health insurance
