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Flex Schedule Remote Lpn Utilization Review Jobs

KYYBA

Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

MI Registered Nurse License Mandatory Requirements to Apply * Active, unrestricted Michigan ... Coordinate training operations, including scheduling, class administration, new hire system access ...

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

... licensure. Conducts primary functions of prior authorization, retrospective review, medical ... For positions that are available as remote work, Sentara Health employs associates in the following ...

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How much do flex schedule remote lpn utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for flex schedule remote lpn utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a flex schedule remote LPN utilization review?

A Flex Schedule Remote LPN Utilization Review is a licensed practical nurse (LPN) who works remotely to assess the necessity and appropriateness of medical treatments and services. The 'flex schedule' aspect means the nurse has flexible working hours, allowing for a better work-life balance. Utilization review involves reviewing patient records, communicating with healthcare providers, and ensuring that care provided meets established guidelines and is covered by insurance policies. This role is vital for healthcare organizations seeking to manage costs while maintaining quality patient care.

What are the key skills and qualifications needed to thrive as a flex schedule remote LPN utilization review nurse?

To excel as a Flex Schedule Remote LPN Utilization Review Nurse, you need an active LPN license, experience in clinical nursing, and a strong understanding of utilization review processes. Familiarity with electronic medical records (EMR) systems, telehealth platforms, and UR-specific software such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective written communication are essential soft skills for accurate case assessments and remote collaboration. These skills ensure appropriate patient care decisions, regulatory compliance, and high-quality service in a flexible, remote environment.

What are some common challenges faced by flex schedule remote LPN utilization review nurses, and how can they be managed?

Flex Schedule Remote LPN Utilization Review nurses often face challenges such as managing time effectively across varying shifts, staying up-to-date with constantly changing healthcare regulations, and maintaining clear communication with interdisciplinary teams while working remotely. To manage these challenges, it's important to establish a structured workflow, utilize organizational tools, participate in ongoing training, and proactively reach out to colleagues through virtual meetings or messaging platforms. Developing strong self-motivation and time management skills can also help ensure productivity and job satisfaction in this remote role.
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Flex Schedule Remote Lpn Utilization Review jobs near you
Infographic showing various Flex Schedule Remote Lpn Utilization Review job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Management Specialist

System One

Baltimore, MD • Remote

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 16 days ago

Job description

Utilization Management Specialist (UM / Utilization Review Nurse) — Remote

Location: 100% Remote (U.S.) — Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension) Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET Pay (W2): USD 51.00/H

Job overview

In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.

What you’ll do

  • Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
  • Make medical necessity / appropriateness determinations and support prior authorizations.
  • Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
  • Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
  • Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
  • Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
  • Maintain accurate documentation and protect PHI while managing a busy caseload.

Required qualifications

  • Active RN or LPN license (RN preferred) — Maryland compact/eligibility required
  • 5+ years clinical nursing experience
  • 2+ years care management / utilization management experience
  • MCG experience (required)
  • Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
  • Strong critical thinking, written communication, and ability to work independently in a remote setting
  • Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
  • Guiding Care and FACETS (required)

Nice to have

  • Critical Care or ER clinical background
  • Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1

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About System One

Sourced by ZipRecruiter

System One helps employers get work done more efficiently and economically without compromising quality. Over our 35+ year history, we've helped connect thousands of talented people with innovative companies. The excitement of a perfect fit motivates us every single day.

Industry

Business consulting services and recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Pittsburgh, PA, US

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