Utilization Review Nurse - Remote at Astrana Health
Location: 600 City Parkway West 10th Floor, Orange, CA 92868
This is a fully remote position.
Astrana Health is looking for an experienced 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 fully remote position.
Empower Entrepreneurial Provider and Care Teams
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
Comply with internal policies and procedures
Active and unrestricted LVN license in California
Candidates with only case management experience are not a fit.
Experience with Microsoft applications such as Word, ...