UM Review Nurse
Astrana Health · United States · US
Utilization Review
Remote/Hybrid — check advert
Nurse
Demand75
Career growth65
Healthcare fit82
Remote potential85
Salary band
USD 34 – 47
5-year outlook
Posted target range is $34-$47/hour; long-term growth likely depends on moving into senior utilization management, appeals, care management, or related payer/health plan roles rather than automatic increases in this position.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-29
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- Nurse
- Rate period
- Hourly
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering for California-licensed LVNs or RNs with prior utilization management experience who want remote, non-bedside work. Less suitable for clinicians without UM experience or those unable to accommodate weekend, holiday, and overtime scheduling.
Who should apply
California-licensed LVNs or RNs with at least one year of outpatient utilization management, prior authorization, or health plan/IPA/MSO experience who are seeking remote utilization review work.
CV angle
Highlight real utilization management, prior authorization, retrospective review, and medical necessity criteria experience. Emphasize health plan/IPA/MSO exposure, regulatory and accreditation knowledge, referrals to medical directors, Microsoft Office proficiency, and collaboration with multidisciplinary teams. Do not claim UM experience if you do not have it; instead frame clinical nursing judgment as transferable to evidence-based review.
Skills to highlight
- Utilization Management
- Prior Authorization
- Retrospective Review
- Medical Necessity Criteria
- Health Plan/IPA/MSO Operations
- Regulatory and Accreditation Compliance
- Interdisciplinary Collaboration
- Microsoft Office
Role summary
Remote California-licensed LVN/RN role reviewing prior authorization and retrospective requests for outpatient services, procedures, post-homecare services, and durable medical equipment against medical necessity criteria and health plan requirements.
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