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Lpn Utilization Review Nurse Jobs (NOW HIRING)

CorVel

CA Utilization Review Nurse I

$30.64 - $45.80/hr

... LVN/LPN * 4 or more years of recent clinical experience * Prospective, concurrent, and ... utilization review experience preferred * Experience in the clinical areas of OR, ICU, CCU, ER and ...

Oscar Health

Utilization Review Nurse

Miami, FL · 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 ...

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Lpn Utilization Review Nurse information

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$68

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

As of Aug 10, 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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What cities are hiring for Lpn Utilization Review Nurse jobs? Cities with the most Lpn Utilization Review Nurse job openings:
What states have the most Lpn Utilization Review Nurse jobs? States with the most job openings for Lpn Utilization Review Nurse jobs include:
What job categories do people searching Lpn Utilization Review Nurse jobs look for? The top searched job categories for Lpn Utilization Review Nurse jobs are:
Lpn Utilization Review Nurse jobs near you
Infographic showing various Lpn Utilization Review Nurse job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

RN Utilization Review Nurse

Healthcare Support Staffing

Troy, MI

$33 - $37/hr

Full-time

Re-posted 23 hours ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Are you an experienced RN Utilization Review Nurse looking for a new opportunity with a prestigious healthcare company as a RN Utilization Review Nurse. Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the RN Utilization Review Nurse position for you!


Company Job Description/Day to Day Duties:

  • Providing utilization review for the Medicaid and Medicare line of business. Primarily inpatient, skilled nurses facilities, rehab, behavioral health, and home healthcare.
  • Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
  • Provider appeals and Utilization reviews and assist with Denial Letters
  • Provides concurrent review and prior authorizations (as needed) according to policy for members as part of the Utilization Management team.
  • Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
  • Participates in interdepartmental integration and collaboration to enhance the continuity of care for members including Behavioral Health and Long Term Care.


Hours for this Position:

  • Mon-Fri: 8:30am - 5pm


Advantages of this Opportunity:

  • Great salary between $33 - 37!
  • Great benefits!!!
  • Fun and positive work environment!
Qualifications

Minimum Education/Qualifications/Licensures:

  • Must be an RN
  • Utilization Review background in either Managed Care of Provider environment (at least one year)
  • Interqual experience (at least one year)
  • Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
  • Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
  • Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
  • Great typing and data entry skills
Additional Information

Interested in being considered?

If you are interested in being considered for this position, please click the apply button below.  Or call John Wood 407-478-0332 ext 225

Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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