About the Role
Astrana Health is looking for a Utilization Review Nurse to assist our Health Services Department. This position will typically work M-F from 8 : 30 .
to 5 . We also require weekend and holiday coverage if there is a business need. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis. 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, Nevada, or 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
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