UM Review Nurse - Texas
Astrana Health is looking for a Utilization Review Nurse with a Texas LVN license to assist our Health Services Department in reviewing a high volume of outpatient and inpatient cases. This position will require open availability from 8:00 AM to 8:00 PM Monday through Sunday. The position will rotate weekend and holiday coverage amongst the team.
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 license in Texas. Compact license preferred.
- Experience with Microsoft applications such as Word, Excel, and Outlook
- 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 fully remote position. Nurses must be licensed in the state of Texas.
- 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 position will operate in PST during the 3 month probationary period. After successful completion of probationary period, position can transition to CST.
- The target pay range for this role is $30.00 - $40.00 per hour. This salary range represents our national target range for this role.
Active and unrestricted LVN license in Texas; 2+ years health plan, IPA or MSO experience; Microsoft Word, Excel, Outlook; open availability 8 AM-8 PM Monday-Sunday; rotating weekend and holiday coverage; overtime required.
Key Responsibilities
- reviewing cases
- referring to medical directors
- maintaining regulations
Skills & Tools
Microsoft Word, Microsoft Excel, Microsoft Outlook
Job Details
- Category: Healthcare Services - Nursing
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — Texas, United States
- Salary: USD 62,400 – 83,200 / year
- Languages: English
About Astrana Health, Inc.
A provider-centric, technology-powered healthcare company enabling providers to deliver accessible, high-quality, and high-value care. — Industry: Healthcare