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Lpn Utilization Review Work From Home Jobs (NOW HIRING)

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

Successful candidates must hold a valid, current license issued by the Massachusetts Board of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Successful candidates must hold a valid, current license issued by the Massachusetts Board of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Successful candidates must hold a valid, current license issued by the Massachusetts Board of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

Successful candidates must hold a valid, current license issued by the Massachusetts Board of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

While your daily work will be completed from your home office, occasional travel may be required ... 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

While your daily work will be completed from your home office, occasional travel may be required ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

While your daily work will be completed from your home office, occasional travel may be required ... 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

While your daily work will be completed from your home office, occasional travel may be required ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Medica

Utilization Management RN III

$70K - $120K/yr

LPN or RN Required. Perform other duties assigned. Key Responsibilities: * Medica's Utilization ... For further information, please review the Know Your Rights notice from the Department of Labor.

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Lpn Utilization Review Work From Home information

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$29

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How much do lpn utilization review work from home jobs pay per hour?

As of Aug 1, 2026, the average hourly pay for lpn utilization review work from home 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 are the key skills and qualifications needed to thrive as an LPN Utilization Review Work From Home, and why are they important?

To excel as an LPN Utilization Review Work From Home, you need a valid LPN license, strong clinical judgment, and experience in patient care or case management. Familiarity with utilization management software, electronic medical records (EMR), and healthcare regulations such as Medicare/Medicaid guidelines is typically required. Exceptional communication, attention to detail, and organizational skills are vital for remote collaboration and accurate documentation. These competencies ensure efficient case review, regulatory compliance, and high-quality patient outcomes in a remote work environment.

What is the difference between Lpn Utilization Review Work From Home vs Lpn Case Manager?

AspectLpn Utilization Review Work From HomeLpn Case Manager
CertificationsLicensed Practical Nurse (LPN), possibly additional certifications in utilization reviewLicensed Practical Nurse (LPN), often with case management certifications
Work EnvironmentRemote, home-basedTypically office or healthcare facility, but can be remote
Primary ResponsibilitiesReview medical necessity, approve or deny insurance claims based on criteriaCoordinate patient care, develop care plans, monitor patient progress
Industry UsageInsurance companies, utilization review organizationsHospitals, healthcare providers, insurance companies

While both roles require an LPN license and involve patient or medical review, Lpn Utilization Review Work From Home focuses on insurance claim assessments remotely, whereas Lpn Case Manager emphasizes direct patient care coordination, often in a healthcare setting.

What are some common challenges faced by LPNs working in utilization review from home, and how can they be managed?

LPNs in utilization review who work from home often encounter challenges such as adapting to remote communication with healthcare teams, balancing productivity with limited in-person supervision, and staying current with healthcare regulations. To manage these, it’s important to establish a dedicated workspace, proactively communicate via email or video calls, and participate in ongoing training provided by employers. Utilizing organizational tools and maintaining regular check-ins with supervisors can also help ensure productivity and collaboration remain strong.

What is an LPN Utilization Review work from home job?

An LPN Utilization Review work from home job involves Licensed Practical Nurses (LPNs) evaluating medical records and patient care data remotely to determine the appropriateness and necessity of healthcare services. They review treatment plans, ensure compliance with insurance guidelines, and help manage healthcare costs by preventing unnecessary procedures. This role typically requires strong clinical knowledge, attention to detail, and excellent communication skills, as LPNs collaborate with other healthcare professionals and insurance companies. Working from home, they use secure electronic systems to access patient information and complete their reviews.

How to Become a Work From Home Utilization Review LPN

To become a work from home LPN utilization review worker, you first need to become a licensed practical nurse. An LPN program awards applicants a diploma or certificate and involves supervised clinical experience. You must become licensed through the NCLEX-PN exam before gaining care experience, participating in on-the-job training, and continuing your education. Hospital practice is often a requirement before you can secure an LPN utilization review role and handle duties effectively. Understanding insurance details and medical language and terminology are critical skills for the job. Diverse in-facility experience is also beneficial, and advanced training and qualifications are ideal. Since this is a telecommute role, you also need computer skills.

More about Lpn Utilization Review Work From Home jobs
What cities are hiring for Lpn Utilization Review Work From Home jobs? Cities with the most Lpn Utilization Review Work From Home job openings:
What states have the most Lpn Utilization Review Work From Home jobs? States with the most job openings for Lpn Utilization Review Work From Home jobs include:
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Lpn Utilization Review Work From Home jobs near you
Infographic showing various Lpn Utilization Review Work From Home job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 72% Full Time, 23% Part Time, and 4% Contract. Highlights an 93% Physical, 1% Hybrid, and 6% Remote job distribution, with an average salary of $62,140 per year, or $29.9 per hour.

PRN Utilization Review Nurse Reviewer

Dane Street, LLC

Remote

Full-time, Per diem

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

New

Job description

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.
Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways.
Our PRN Nursing Program is designed for flexible, as-needed staffing to support our team during peak times, weekends, and holidays.
  • PRN nurses will be required to work at least one weekend per month, one major holiday, and one minor holiday per year.
  • A minimum number of shifts per month will be mandated to ensure that PRN nurses maintain their QA skills and familiarity with processes.

MAJOR DUTIES & RESPONSIBILITIES
  • Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
  • Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
  • Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
  • Input and manage essential clinical details within various medical management platforms.
  • Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
  • Apply clinical reasoning to determine the suitable evidence-based guidelines.
  • Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements
  • Proficient in both written and spoken communication.
  • Capable of maintaining professional communication with physicians and clients.
  • Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
  • Possesses a keen organizational sense and pays close attention to details.
  • Adept at resolving intricate and multifaceted problems.
  • Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
  • Background in medical or clinical practice through education, training, or professional engagement.
  • Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Additional Duties
  • May provide oversight to the work of the team members.
  • Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction.
  • Responsible for the final approval on cases for release to the client.
  • Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.

EDUCATION/CREDENTIALS:
Licensed Practical/Vocational Nurse with an active and unrestricted license to practice.
JOB RELEVANT EXPERIENCE:
2 yrs minimum clinical nursing experience is required.
One year of previous experience in Utilization Management is required.
JOB RELATED SKILLS/COMPETENCIES:
Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.
WORK FROM HOME TECHNICAL REQUIREMENTS:
Supply and support their own internet services.
Maintaining an uninterrupted internet connection is a requirement of all work from home position.
Requirements
Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.
Our Commitment:
We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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