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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 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 ...

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Lpn Utilization Management information

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How much do lpn utilization management jobs pay per hour?

As of Jun 25, 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.

How to get into utilization management as a nurse?

To become a nurse in utilization management, typically, you need to have an active nursing license and experience in clinical care or case management. Many employers prefer candidates with knowledge of healthcare policies, coding, and documentation, and some roles require certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ). Gaining experience in case management or health insurance settings can also improve your prospects in this field.

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.

What is the highest paying job for LPN?

The highest paying roles for Licensed Practical Nurses (LPNs) often include positions such as LPNs in specialized settings like anesthesia or IV therapy, or roles in management and education. Advanced certifications and experience can lead to higher salaries, but typically, LPNs in outpatient clinics, home health, or working overtime tend to earn the most within the LPN career path.

What are the chillest nursing jobs?

LPN Utilization Management roles are generally considered less physically demanding and involve administrative tasks, making them relatively relaxed compared to bedside nursing. These positions often feature regular hours, minimal emergency situations, and focus on reviewing patient data and coordinating care, which can contribute to a calmer work environment.

What are the key skills and qualifications needed to thrive as an LPN Utilization Management Nurse, and why are they important?

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.

Can an LPN be a utilization review nurse?

An LPN can serve as a utilization review nurse in some healthcare settings, but their scope of practice is more limited than that of an RN. Typically, utilization review roles require a registered nurse license and involve assessing medical necessity and appropriateness of care, often requiring additional training or certification. LPNs may assist in data collection and preliminary reviews but usually do not perform comprehensive utilization reviews independently.
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Lpn Utilization Management jobs near you
Infographic showing various Lpn Utilization Management job openings in the United States as of June 2026, with employment types broken down into 2% Internship, 1% As Needed, 59% Full Time, 9% Part Time, and 29% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $62,140 per year, or $29.9 per hour.
Utilization Management LPN

Utilization Management LPN

Allmed Staffing Inc

Pearland, TX • Remote

$40/hr

Other

Medical, Dental, Vision, Retirement

Posted 2 days ago

Job description

Job Title: Utilization Management LPN
Allmed Benefits: Vision Insurance, Health Insurance, Dental Insurance and 401(k)
Pay Rate: $40/hr (Paid Weekly)
Work Location: 11511 SHADOW CREEK Pkwy, Pearland, TX
Contract: 05/11/2026 to 08/07/2026
Schedule: Monday – Friday, 8:00 AM – 5:00 PM

Position Overview:

The Utilization Management LPN supports daily utilization management operations by reviewing authorization requests, ensuring timely and accurate processing, and maintaining compliance with health plan and regulatory requirements. This role is essential in supporting workflow efficiency, particularly during periods of increased volume or team coverage needs.

Team Environment:

This position reports to a supervisor and works within a collaborative team of approximately 10–11 members. The team includes licensed nurses and utilization management professionals dedicated to meeting service level agreements, productivity goals, and quality standards in a fast-paced environment.

Key Responsibilities:

  • Review and process authorization requests, including consults, follow-up visits, and procedures
  • Apply medical necessity criteria such as InterQual and evaluate plan benefits
  • Ensure accurate and timely documentation within EPIC or similar systems
  • Communicate authorization decisions and status updates to providers verbally and in writing
  • Maintain compliance with regulatory, quality, and audit requirements
  • Support high-volume work queues and assist with coverage needs
  • Coordinate redirection of services, benefit clarification, and continuity of care
  • Meet established productivity, turnaround time, and quality benchmarks
  • Assist with workflow improvements and departmental goals as needed

Qualifications:

Required:

  • Active LVN/LPN license in a Compact State or Texas
  • Minimum 2 years of clinical experience, preferably in utilization management or managed care
  • Strong knowledge of medical terminology and clinical workflows
  • Experience applying medical necessity criteria such as InterQual
  • Excellent communication, documentation, and organizational skills
  • Ability to multitask, prioritize workload, and meet deadlines

Preferred:

  • Previous Utilization Management or Prior Authorization experience
  • Experience with EPIC and/or IQ Cloud systems
  • Knowledge of Medicare Advantage and Commercial plan requirements
  • Strong understanding of compliance, audits, and regulatory processes
  • Ability to work independently in a remote environment

Additional Information:

  • License Required: Yes – Active LVN/LPN (Compact State or Texas)
  • Dress Code: Business casual (remote-appropriate)
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