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Lpn Utilization Review Work From Home Jobs in Raleigh, NC

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Lpn Utilization Review Work From Home information

See Raleigh, NC salary details

$15

$29

$42

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

As of Sep 6, 2026, the average hourly pay for lpn utilization review work from home in Raleigh, NC is $29.04, according to ZipRecruiter salary data. Most workers in this role earn between $24.09 and $32.69 per hour, depending on experience, location, and employer.

What is an LPN utilization review work from home?

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 an LPN utilization review work from home?

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.

What are the key skills and qualifications needed to thrive as an LPN utilization review work from home?

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 are 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 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.

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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 Raleigh, NC as of August 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 100% Remote job distribution, with an average salary of $60,402 per year, or $29 per hour.

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Re-posted yesterday

Job description

About The Role
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Primary Responsibilities
•    Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures.
•    Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments.
•    Collaborates with healthcare partners to ensure timely review of services and care.
•    Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed.
•    Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
•    Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate.
•    Triages and prioritizes cases and other assigned duties to meet required turnaround times.
•    Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations.
•    Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements.
•    Duties as assigned.
Essential Qualifications
•    Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment.
•    Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
•    Must be able to work independently.
•    Must be detail oriented and have strong organizational and time management skills.
•    Adaptive to a high pace and changing environment- flexibility in assignment.
•    Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review.
•    Proficient in MCG and CMS criteria sets
•    Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.
•    Working knowledge of URAC and NCQA.
•   2+ years’ experience in a UM team within managed care setting.
•   3+ years’ experience in clinical nurse setting preferred.
•   TPA Experience preferred.
 

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