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Lpn Utilization Review Nurse Jobs (NOW HIRING)

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND ... Current Massachusetts Nursing license * Bachelor's degree. - Preferred * 5 years case management ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...

Pride Health

Utilization Review Nurse

Queens, NY · On-site

$2.8K/wk

Required Certifications & Licensure: New York State RN License & Primary Source Verification. AHA BLS. 1+ year of non-acute utilization review experience Skills: * Strong clinical assessment ...

New

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

... to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND ... Current Massachusetts Nursing license * Bachelor's degree. - Preferred * 5 years case management ...

Houston Healthcare

$80 - $100/hr

Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of ... Current US state RN license with authorization to practice in the state of GA. Knowledge, Skills ...

New

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$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 ...

CorVel Corporation

$85 - $110/hr

RN is required unless local state regulations permit LVN/LPN * 4 or more years of recent clinical experience * Prospective, concurrent, and retrospective utilization review experience preferred

New

Voyage Health

Travel RN Utilization Review

Torrance, CA · On-site

$1.8K - $1.9K/wk

Position Details Specialty: RN Utilization Review Location: Torrance, California Employment Type: Travel/Contract Pay: $1816 - $1912 per week Shift: 5x8 Days Start Date: ASAP Contract Length: 13-week ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ... Utilization management experience LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$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 ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...

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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 Sep 2, 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 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.

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 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.

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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, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse | Full Time

Lancesoft INC

Las Vegas, NV • On-site

$41 - $60/hr (+ commission)

Full-time

Medical, Dental, Life

Re-posted 5 days ago

Job description

Job Description – Utilization Review Nurse

Position Summary
The Utilization Review Nurse is responsible for reviewing patient admissions and ongoing hospital stays to ensure the delivery of medically necessary, appropriate, and cost-effective care. This role evaluates clinical documentation against established utilization review criteria, payer requirements, and regulatory standards while collaborating with physicians, case managers, and interdisciplinary teams to optimize patient outcomes and resource utilization.

Key Responsibilities

  • Review patient admissions and continued stays for medical necessity, appropriateness of care, and compliance with payer guidelines.
  • Apply InterQual and Milliman criteria to determine appropriate levels of care.
  • Ensure compliance with Medicare, Medicaid, commercial insurance, and regulatory requirements.
  • Analyze medical records to verify accurate clinical documentation and identify opportunities for improvement.
  • Collaborate with physicians, case managers, clinical documentation specialists, and other healthcare professionals to facilitate appropriate patient care and discharge planning.
  • Participate in utilization management activities, including concurrent reviews, appeals, and denial prevention.
  • Maintain accurate documentation of utilization review findings and recommendations.
  • Monitor resource utilization while supporting quality patient care and organizational goals.
  • Stay current with healthcare regulations, accreditation standards, and utilization management best practices.

Qualifications

Education

  • Graduate of an accredited School of Nursing.

Experience

  • Minimum 5 years of acute care clinical nursing experience.
  • At least 3 years of Utilization Management experience.
  • Minimum 3 years of discharge planning experience in an acute care setting.
  • Experience in Case Management or Clinical Documentation Improvement is preferred.

Licensure & Certifications

  • Current, unrestricted Registered Nurse (RN) license in the State of Nevada.
  • Demonstrated proficiency with InterQual criteria and ability to successfully complete the InterQual examination.
  • Recent experience utilizing Milliman Care Guidelines (MCG).

Required Knowledge & Skills

  • Strong understanding of utilization review principles, payer guidelines, Medicare/Medicaid regulations, and accreditation standards.
  • Excellent clinical assessment and critical thinking skills.
  • Ability to interpret medical records and determine medical necessity.
  • Strong communication, collaboration, and interpersonal skills.
  • Proficiency in electronic medical records (EMR) and Microsoft Office applications.
  • Ability to prepare reports, analyze data, and communicate findings effectively.

Working Conditions

This position is primarily office-based within an acute care hospital environment and requires prolonged computer use, reviewing medical records, and frequent collaboration with clinical teams. Occasional weekend or shift work may be required based on operational needs.

Company Description

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.

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About LanceSoft

Sourced by ZipRecruiter

Established in 2000, LanceSoft is a Certified MBE and Woman-Owned organization. Lancesoft Inc. is one of the highest rated companies in the industry. We have been recognized as one of the Largest Staffing firms and ranked in the top 50 fastest Growing Healthcare Staffing firms in 2022. Lancesoft offers short- and long-term contracts, permanent placements, and travel opportunities to credentialed and experienced professionals throughout the United States. We pride ourselves on having industry leading benefits. We understand the importance of partnering with an expert who values your needs, which is why we're 100% committed to finding you an assignment that best matches your career and lifestyle goals. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.LanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Herndon, VA, US

Year founded

2000

Social media

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