UM Review Nurse

Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Astrana Health is looking for a Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position will typically work M-F 8 AM - 5 PM. This is a fully remote position. Environmental Job Requirements and Working Conditions: This is a remote position. Candidates must be located in California. This position will typically work Monday - Friday from 8:00 am to 5:00 pm. There may be up to 1 hour of voluntary OT per day. The target pay range for this role is $30.00 - $34.00 per hour. This salary range represents our national target range for this role.

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