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Lpn Utilization Management Jobs (NOW HIRING)

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... Successful candidates must hold a valid, current license issued by the Massachusetts Board of ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... Successful candidates must hold a valid, current license issued by the Massachusetts Board of ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... Successful candidates must hold a valid, current license issued by the Massachusetts Board of ...

Humana

Utilization Management Nurse

The Utilization Management Nurse 2 work assignments are varied and frequently require ... Licensed Practical Nurse (LPN) with at least 5 years of clinical experience in acute care, skilled ...

Humana

Utilization Management Nurse

The Utilization Management Nurse 2 work assignments are varied and frequently require ... Licensed Practical Nurse (LPN) with at least 5 years of clinical experience in acute care, skilled ...

Summa Health System

RN Utilization Management

Akron, OH · On-site

$37.40 - $56.11/hr

RN Utilization Management Full-Time Days Akron Campus Summa Health System is recognized as one of ... Current license to practice registered nursing in the State of Ohio 2. Experience & Training ...

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LPN Utilization Management information

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$15

$29

$43

How much do lpn utilization management jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for lpn utilization management in the United States is $29.88, according to ZipRecruiter salary data. Most workers in this role earn between $24.76 and $33.65 per hour, depending on experience, location, and employer.

What is an LPN Utilization Management nurse?

An LPN Utilization Management nurse is a Licensed Practical Nurse who works within the healthcare system to review and evaluate the necessity, appropriateness, and efficiency of healthcare services and treatments. Their primary role is to help ensure patients receive the right care while managing healthcare costs and resources effectively. They often work with insurance companies, hospitals, or clinics, collaborating with other healthcare professionals to make determinations about coverage and care plans. This position requires strong analytical skills, communication abilities, and a solid understanding of medical guidelines and regulations.

What are the key skills and qualifications needed to thrive as an LPN Utilization Management nurse?

To thrive as an LPN Utilization Management Nurse, you need a current LPN license, strong clinical knowledge, and experience in care coordination or case management. Familiarity with utilization review software, electronic health records (EHRs), and compliance tools is often required, along with knowledge of insurance and regulatory guidelines. Excellent communication, critical thinking, and organizational skills are crucial for collaborating with healthcare teams and advocating for patients. These skills ensure effective resource utilization, regulatory compliance, and high-quality patient outcomes.

What are some common challenges LPNs face in utilization management roles, and how can they be addressed?

LPNs in Utilization Management often encounter challenges such as interpreting complex medical records, balancing administrative tasks with clinical judgment, and keeping up with evolving insurance guidelines. To address these, it's helpful to develop strong attention to detail, stay current with payer requirements, and seek mentorship or ongoing training in medical coding and documentation. Collaboration with RNs, physicians, and case managers is key to overcoming these hurdles and ensuring accurate, efficient patient care assessments.

What is the difference between Lpn Utilization Management vs Lpn Case Management?

AspectLpn Utilization ManagementLpn Case Management
CertificationsLicensed Practical Nurse (LPN)Licensed Practical Nurse (LPN)
Work EnvironmentInsurance companies, utilization review departmentsHospitals, clinics, community health settings
Primary FocusReviewing medical necessity and insurance coverageCoordinating patient care and discharge planning
Employer & Industry UsageInsurance providers, managed care organizationsHealthcare facilities, outpatient clinics

While both roles require an LPN license, Lpn Utilization Management focuses on reviewing medical necessity for insurance purposes, whereas Lpn Case Management emphasizes coordinating patient care and discharge planning. Understanding these differences helps in choosing the right career path or job search focus within healthcare.

More about LPN Utilization Management jobs

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Cities with the most Lpn Utilization Management job openings:

What states have the most Lpn Utilization Management jobs?

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LPN Utilization Management jobs near you
Infographic showing various Lpn Utilization Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $62,140 per year, or $29.9 per hour.

RN Utilization Management Reviewer

Sagility

Concord, NC • Remote

$35 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 12 days ago

Sagility rating

4.6

Company rating: 4.6 out of 10

Based on 29 frontline employees who took The Breakroom Quiz

62nd of 71 rated call and contact centers

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title:

RN Utilization Management Reviewer

Job Description:

We are currently hiring a talented RN, Utilization Management Reviewer. This role will be responsible in day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS compliance standards in the area of service decisions and organizational determinations. Successful candidates must hold a valid, current license issued by the Massachusetts Board of Registration in Nursing.

Key responsibilities:

  • Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports (LTSS), and Home Health (HH)
  • Applies established criteria (e.g., InterQual and other available guidelines) and employs clinical expertise to interpret clinical criteria to determine medical necessity of services
  • Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements
  • Provides decision-making guidance to clinical teams on service planning as needed
  • Works closely with Clinicians, Medical Staff and Peer Reviewers to facilitate escalated reviews in accordance with Standard Operating Procedures
  • Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
  • Works with UM Manager and other clinical leadership to ensure that departmental and organizational policies and procedures as well as regulatory and contractual requirements are met
  • Additional duties as requested by supervisor
  • Maintains knowledge of CMS, State and NCQA regulatory requirements

Education Requirements:

  • RN - Associate's Degree required, Bachelor's Degree preferred
  • RN, current license issued by the Massachusetts Board of Registration in Nursing
  • CCM (Certified Case Manager) a plus

Required Experience (must have):

  • 1 to 2 years Utilization Management experience.
  • 2 or more years working in a clinical setting

Desired Experience (nice to have):

  • 2 or more years of Home Health Care experience
  • 2 or more years working in a Medicare Advantage health Plan

Required Knowledge, Skills & Abilities (must have):

  • Ability to complete assigned work in a timely and accurate manner
  • Knowledge of the Utilization management process
  • Ability to work independently

Desired Knowledge, Skills, Abilities & Language (nice to have):

  • Ability to apply predetermined criteria (e.g., Medical Necessity Guidelines, InterQual) to service decision requests to assess medical necessity
  • Flexibility and understanding of individualized care plans
  • Ability to influence decision making
  • Strong collaboration and negotiation skills
  • Strong interpersonal, verbal, and written communication skills
  • Comfort working in a team-based environment
  • Knowledge of Medicare and Mass health services and benefits

Salary: $35.00 - $40.00 Hourly pending experience.

Hours: Monday through Friday 9AM to 5:30PM Eastern Time. May require weekends

This is a fully remote work at home role. You must have a secure, private wok at home area with a hardwired internet connection with speeds greater than 5MB upload and 10MB download.

Sagility Offers Competitive Benefits Including:

  • Medical
  • Dental
  • Vision
  • Life Insurance
  • Short-Term and Long-Term Disability
  • Flexible Spending Account
  • Life Assistance Program
  • 401K with employer contribution
  • PTO and Sick Time
  • Tuition Reimbursement

Join our team, we look forward to talking with you!

An Equal Opportunity Employer/Vet/Disability

Location:

Work@Home USAUnited States of America

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