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Lpn Utilization Review Jobs (NOW HIRING)

Genesis Healcare

RN - Utilization Review

Albuquerque, NM · On-site

$2.4K/wk

Active state licensure in [specify relevant states] (e.g., RN, LPN, PT, OT). Minimum [number] years of experience in [specialty]. BLS/CPR certification (ACLS, PALS, or others as required by specialty)

talent4health

RN - Utilization Review

Cleveland, OH · On-site

$2.2K/wk

... Utilization Review Job ID 18807560 Job Title RN - Utilization Review Weekly Pay $2214.0 Shift ... Current licensure by Ohio State Board of Nursing. * Minimum of five (5) years recent experience in ...

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How much do lpn utilization review jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for lpn utilization review 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 Review?

An LPN Utilization Review (UR) job involves evaluating medical services to ensure they are necessary, cost-effective, and meet healthcare guidelines. LPNs in this role review patient records, collaborate with healthcare providers, and verify insurance coverage for treatments. They help prevent unnecessary procedures and control healthcare costs while ensuring patients receive appropriate care. This position typically requires strong analytical skills, attention to detail, and knowledge of medical policies.

How do I become a licensed practical nurse utilization review?

To become a licensed practical nurse (LPN) involved in utilization review, you must complete a state-approved LPN education program and pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN). Gaining experience in medical or healthcare settings and developing skills in patient assessment and documentation can also support a transition into utilization review roles.

Can an LPN become a utilization review nurse?

Yes, an LPN can become a utilization review nurse, but they typically need additional training or certification in utilization review, case management, or health insurance processes. Many employers prefer or require experience in nursing and knowledge of medical coding, documentation, and healthcare policies for this role.

What are the typical daily responsibilities of an LPN Utilization Review?

LPN Utilization Review nurses typically spend their day reviewing patient records to ensure that medical care meets established guidelines for necessity and efficiency. They collaborate with physicians, registered nurses, and insurance representatives to verify the appropriateness of treatments and authorizations for procedures or hospital stays. The role often includes documenting findings, communicating approvals or denials, and sometimes participating in appeals processes. This position provides a mix of independent case assessment and teamwork, making it ideal for those who value both analytical work and interpersonal collaboration.

What are the key skills and qualifications needed to thrive in the LPN Utilization Review position, and why are they important?

To thrive as an LPN Utilization Review nurse, you need a current LPN license, a solid understanding of clinical procedures, and experience with medical record review. Familiarity with utilization management software, electronic health records (EHRs), and possibly certification in case management or utilization review is often required. Strong attention to detail, critical thinking, and effective communication skills are also essential for success in this position. These competencies help ensure accurate assessments, efficient workflow, and effective collaboration between healthcare providers, payers, and patients.

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What are the most commonly searched types of Lpn Utilization Review jobs? The most popular types of Lpn Utilization Review jobs are:
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Lpn Utilization Review jobs near you
Infographic showing various Lpn Utilization Review job openings in the United States as of August 2026, with employment types broken down into 82% Full Time, and 18% Contract. Highlights an 91% In-person, and 9% Remote job distribution, with an average salary of $62,140 per year, or $29.9 per hour.

Utilization Review Specialist (FLEXI)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Medical

Posted 29 days ago

Chesapeake Regional Healthcare rating

6.9

Company rating: 6.9 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

Job description

Summary
The Utilization Review Specialist supports the organization's utilization management program by conducting routine admission, concurrent, and retrospective reviews utilizing established screening criteria and organizational guidelines. This position collects, reviews, and documents clinical information to support medical necessity determinations and appropriate resource utilization. Complex, high-risk, or ambiguous cases requiring clinical judgment are referred to a RN Utilization Review for review and determination.
Essential Duties and Responsibilities
These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
  • Conduct routine utilization reviews using approved screening criteria, established workflows, and departmental guidelines.
  • Collect and organize clinical documentation necessary to support utilization review activities.
  • Review patient records to identify required information for admission, continued stay, and discharge planning processes.
  • Apply established criteria to routine cases and document findings in designated systems.
  • Monitor assigned cases for required documentation and timely review completion.
  • Communicate with providers, clinical staff, payers, and care team members to obtain necessary information.
  • Identify cases that do not clearly meet established criteria and escalate them to an RN Utilization Review.
  • Present complex, high-acuity, disputed, or clinically ambiguous cases to an RN Utilization Review Specialist for evaluation and determination.
  • Assist with obtaining payer authorizations and tracking authorization status as directed.
  • Maintain accurate utilization management records, reports, and audit documentation.
  • Support denial prevention efforts through timely documentation and communication.
  • Participate in quality improvement initiatives related to utilization management processes.
  • Maintain knowledge of applicable payer requirements, regulatory standards, and organizational policies.
  • Assist with data collection and reporting related to utilization management metrics.
  • Perform other utilization management support duties within the scope of licensure and training.

Supervisory Responsibilities
Reports to: RN Clinical Doc Manager
Supervises: N/A
Responsibilities: N/A
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Experience
Minimum Required Education
Graduate of an approved healthcare program leading to licensure as a healthcare professional i.e. Licensed Practical Nurse (LPN) or other clinically licensed healthcare professionals as approved by the organization.
Experience
Two (2) years of clinical healthcare experience required. Experience in utilization review, utilization management, case management, care coordination, discharge planning, or other related clinical healthcare functions may be considered.
Certificates, Licenses, Registrations
  • Current unrestricted license as a Licensed Practical Nurse required at minimum in the Commonwealth of Virginia or compact state. Candidates possessing a higher level of clinical licensure are also eligible for consideration.
  • Certification in utilization management or case management preferred.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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