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Full Time Remote Lpn Utilization Review Jobs in Raleigh, NC

Valeris

Remote Registered Nurse (RN) Case Manager

Raleigh, NC · Remote

$50K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Serve as an educator who possesses knowledge and practical experience about clinical treatments and ... Must have active RN licensure in current state of practice. * 2-3 years of nursing experience with ...

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All JobsLpn Utilization Review JobsFull Time Remote Lpn Utilization Review JobsFull Time Remote Lpn Utilization Review Jobs in Raleigh, NC

Full Time Remote Lpn Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

How much do full time remote lpn utilization review jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for full time remote lpn utilization review in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.

What is the difference between Full Time Remote Lpn Utilization Review vs Full Time Remote Lpn Case Management?

AspectFull Time Remote Lpn Utilization ReviewFull Time Remote Lpn Case Management
CertificationsLicensed Practical Nurse (LPN), possibly Utilization Review certificationLicensed Practical Nurse (LPN), Case Management certification often preferred
Work EnvironmentRemote, reviewing medical records for insurance or healthcare providersRemote, coordinating patient care and discharge planning
Employer & IndustryInsurance companies, healthcare organizationsHospitals, healthcare providers, insurance companies

Both roles require LPN licensure and involve remote work, but Utilization Review focuses on assessing medical necessity, while Case Management emphasizes coordinating patient care. Understanding these differences helps job seekers find the right fit based on their skills and career goals.

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Full Time Remote Lpn Utilization Review jobs near you

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Re-posted 13 days ago

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

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