Astrana Health

Technology-enabled platform delivering value-based care

Utilization Management Nurse

Medical, Clinical & VeterinaryUpdated on Nov 13

Full-timeCalifornia, USA$34 - $47 /hr

About the Job

Requirements

At least one year of outpatient Utilization Management experience in a fast-paced setting.
An active and unrestricted LVN or RN license in California.
Experience with Microsoft applications such as Word, Excel, and Outlook.

Responsibilities

Use clinical judgment to approve or deny outpatient medical services based on Medical Necessity Criteria for various Health Plans.
Complete prior authorization and retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment.
Refer cases to Medical Directors as needed or appropriate.
Maintain knowledge of state and federal regulations and accreditation standards.
Comply with internal policies and procedures.
Perform other job duties as requested.

Desired Qualifications

Two years of health plan, IPA, or MSO experience.
Experience educating and training staff.

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 is a remote position for CA-licensed nurses. Candidates must live in California.

We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.

Our Values:

Put Patients First
Empower Entrepreneurial Provider and Care Teams
Operate with Integrity & Excellence
Be Innovative
Work As One Team

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

Active and unrestricted LVN or RN license in California,
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

About the Company

Astrana Health

Technology-enabled platform delivering value-based care

Astrana Health runs a physician-focused, technology-enabled care platform that supports providers in delivering proactive, preventive, value-based care. Its end-to-end system coordinates care across affiliated networks, a management services organization, and primary, specialty, and ancillary clinics to help more than 20,000 providers and over 1.6 million Americans in value-based arrangements. How it works: the proprietary platform connects clinicians, patients, and care settings, enabling proactive care planning, care coordination, and efficient delivery of services in primary and specialty care. The company differentiates itself by combining a large provider network, an MSO, and clinics with a single tech platform to scale value-based care and improve patient experiences and outcomes rather than relying on fragmented, fee-for-service models. Its goal is to create a healthcare system that delivers better care, better experiences, and better outcomes for all.

Company size: 501-1,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Alhambra, CA
Founded: Not listed

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