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Lpn Utilization Review Nurse Jobs (NOW HIRING)

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 ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Active, unrestricted Registered Nurse (RN) license. * Associate Degree in Nursing (ADN) required ... Utilization Management (UM) * Medical Necessity Review * Prior Authorization * Precertification

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Talent4Health

RN - Utilization Review

Fort Myers, FL · On-site

$1.9K/wk

Details Client Name Lee Health-Corporate Center Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 37756397 Job Title RN - Utilization Review Weekly Pay $1966.0 Shift ...

Posted today

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

Active and unrestricted RN licensure in state of residence Questionnaire: * Do you have experience ... Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License?

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Lpn Utilization Review Nurse information

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How much do lpn utilization review nurse jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for lpn utilization review nurse 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 the difference between Lpn Utilization Review Nurse vs Lpn Case Manager?

AspectLpn Utilization Review NurseLpn Case Manager
CertificationsLicensed Practical Nurse (LPN), possibly additional certifications in utilization reviewLicensed Practical Nurse (LPN), often with case management or care coordination certifications
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsHospitals, clinics, insurance companies, community health settings
Primary FocusAssessing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning
Employer & Industry UsageInsurance providers, healthcare organizationsHospitals, healthcare agencies, insurance companies

While both roles involve patient care and healthcare assessment, the Lpn Utilization Review Nurse primarily focuses on evaluating the necessity of services, whereas the Lpn Case Manager concentrates on coordinating ongoing patient care and discharge planning. Understanding these differences helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as an LPN Utilization Review Nurse?

To thrive as an LPN Utilization Review Nurse, you need a valid LPN license, strong clinical knowledge, and experience in patient care or case management. Familiarity with medical coding systems (like ICD-10 and CPT), electronic health records (EHRs), and utilization review software is typically required. Excellent analytical thinking, attention to detail, and effective communication skills help you evaluate cases and collaborate with healthcare teams. These skills ensure accurate review of medical records, compliance with regulations, and optimal patient outcomes while controlling healthcare costs.

What are some common challenges faced by LPN Utilization Review Nurses, and how can they be managed?

LPN Utilization Review Nurses often encounter challenges such as managing high caseloads, staying current with ever-changing insurance policies, and ensuring timely communication with interdisciplinary teams. Balancing the need for thorough documentation with efficiency can also be demanding. To manage these challenges, it's helpful to develop strong organizational skills, maintain open communication with colleagues, and participate in ongoing training to keep up with policy changes and best practices.

What does an LPN Utilization Review Nurse do?

An LPN Utilization Review Nurse evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance requirements to ensure compliance with established guidelines and regulations. Their work helps determine whether proposed healthcare services are covered and assists in preventing unnecessary treatments, ensuring cost-effective patient care. These nurses collaborate closely with physicians, insurance companies, and other healthcare professionals.
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Lpn Utilization Review Nurse jobs near you
Infographic showing various Lpn Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Specialist (FLEXI)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Medical

Re-posted 6 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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