UM Review Nurse
full-time•Monterey Park•$0k - $0k
Summary
Location
Monterey Park
Salary
$0k - $0k
Type
full-time
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About this role
UM Review Nurse
Department: HS - UM
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Sandra Castellon
Compensation: $30.00 - $34.00 / hour
Description
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In 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 hybrid position where you will work at-home and in our Monterey Park office on a weekly basis.
We are open to nurses without prior UM experience!
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 hybrid position where you will work at-home and in our Monterey Park office on a weekly basis.
We are open to nurses without prior UM experience!
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
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 CA license.
- 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
Environmental Job Requirements and Working Conditions
- This is a hybrid position, where you will work at home and in-office on a weekly basis.
- 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 $30.00 - $34.00 per hour. Actual compensation will be determined based on 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 [email protected] 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.
Other facts
Tech stack
Utilization Review,Clinical Judgement,Interpersonal Skills,Collaboration,Microsoft Applications,Education,Training,Regulatory Knowledge
About Astrana Health, Inc.
Astrana Health is a physician-centric, technology-enabled healthcare company committed to delivering access to high-quality, patient-centered care. Through its proprietary end-to-end technology platform, Astrana empowers providers to deliver more proactive, preventive care - improving patient outcomes, elevating patient experiences, improving the well-being of providers, and driving greater value.
Today, Astrana supports more than 20,000 providers and over 1.6 million Americans in value-based arrangements through its affiliated provider networks, management services organization, and primary, specialty, and ancillary care delivery clinics.
Together, Astrana is building what our healthcare system should be - one that delivers better care, better experiences, and better outcomes for all. For more information, visit www.astranahealth.com.
Team size: 1,001-5,000 employees
Website: http://www.astranahealth.com
LinkedIn: Visit
Industry: Hospitals and Health Care
What you'll do
- The UM Review Nurse will complete prior authorization and retrospective reviews of medical services and maintain knowledge of regulations and accreditation standards. They will also refer cases to Medical Directors as needed and comply with internal policies.
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Frequently Asked Questions
What does Astrana Health, Inc. pay for a UM Review Nurse?
Astrana Health, Inc. offers a competitive compensation package for the UM Review Nurse role. The salary range is USD 0k - 0k per year. Apply through Clera to learn more about the full compensation details.
What does a UM Review Nurse do at Astrana Health, Inc.?
As a UM Review Nurse at Astrana Health, Inc., you will: the UM Review Nurse will complete prior authorization and retrospective reviews of medical services and maintain knowledge of regulations and accreditation standards. They will also refer cases to Medical Directors as needed and comply with internal policies..
Why join Astrana Health, Inc. as a UM Review Nurse?
Astrana Health, Inc. is a leading Hospitals and Health Care company. The UM Review Nurse role offers competitive compensation.
Is the UM Review Nurse position at Astrana Health, Inc. remote?
The UM Review Nurse position at Astrana Health, Inc. is based in Monterey Park, California, United States. Contact the company through Clera for specific work arrangement details.
How do I apply for the UM Review Nurse position at Astrana Health, Inc.?
You can apply for the UM Review Nurse position at Astrana Health, Inc. directly through Clera. Click the "Apply Now" button above to start your application. Clera's AI-powered platform will help match your profile with this opportunity and guide you through the application process. You can also learn more about Astrana Health, Inc. on their website.