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Lpn Utilization Review Jobs in Raleigh, NC (NOW HIRING)

Granville Health System

LPN/ RN

Oxford, NC

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

Granville Health System

LPN/ RN

Oxford, NC · On-site

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

Granville Health System

LPN/ RN

Oxford, NC

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

Granville Health System

LPN/ RN

Oxford, NC · On-site

$25 - $34/hr

... utilization of the nursing process in collaboration with other health team members. The LPN or RN ... will be responsible for meeting the standards required by JCAHO, GHS, and other regulating agencies ...

MGA Homecare

LPN

Fuquay Varina, NC · On-site

$21.25 - $29/hr

LPN Job Overview Title LVN/LPN- Non-Exempt Job Summary Under limited supervision, the licensed ... Appropriate utilization of all available services is demonstrated and documented. * Participation ...

MGA Homecare

LPN

Chapel Hill, NC · On-site

$22 - $29.75/hr

LPN Job Overview Title LVN/LPN- Non-Exempt Job Summary Under limited supervision, the licensed ... Appropriate utilization of all available services is demonstrated and documented. * Participation ...

Mgahomecare

LPN

Fuquay Varina, NC · On-site

$21.25 - $29/hr

LPN Job Overview Title LVN/LPN- Non-Exempt Job Summary Under limited supervision, the licensed ... Appropriate utilization of all available services is demonstrated and documented. * Participation ...

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All JobsLpn Utilization Review JobsLpn Utilization Review Jobs in Raleigh, NC

Lpn Utilization Review information

See Raleigh, NC salary details

$15

$29

$42

How much do lpn utilization review jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for lpn utilization review 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?

An LPN Utilization Review (UR) job involves evaluating medical services to ensure they are necessary, cost-effective, and meet healthcare guidelines. LPNs in this role review patient records, collaborate with healthcare providers, and verify insurance coverage for treatments. They help prevent unnecessary procedures and control healthcare costs while ensuring patients receive appropriate care. This position typically requires strong analytical skills, attention to detail, and knowledge of medical policies.

What are the typical daily responsibilities of an LPN Utilization Review?

LPN Utilization Review nurses typically spend their day reviewing patient records to ensure that medical care meets established guidelines for necessity and efficiency. They collaborate with physicians, registered nurses, and insurance representatives to verify the appropriateness of treatments and authorizations for procedures or hospital stays. The role often includes documenting findings, communicating approvals or denials, and sometimes participating in appeals processes. This position provides a mix of independent case assessment and teamwork, making it ideal for those who value both analytical work and interpersonal collaboration.

What are the key skills and qualifications needed to thrive in the LPN Utilization Review position, and why are they important?

To thrive as an LPN Utilization Review nurse, you need a current LPN license, a solid understanding of clinical procedures, and experience with medical record review. Familiarity with utilization management software, electronic health records (EHRs), and possibly certification in case management or utilization review is often required. Strong attention to detail, critical thinking, and effective communication skills are also essential for success in this position. These competencies help ensure accurate assessments, efficient workflow, and effective collaboration between healthcare providers, payers, and patients.

Can an LPN become a utilization review nurse?

Yes, an LPN can become a utilization review nurse, but additional training or certification in utilization review or case management may be required. Many employers prefer candidates with experience in nursing, strong analytical skills, and knowledge of healthcare policies and documentation processes.

How do I become a licensed practical nurse utilization review?

To become a licensed practical nurse (LPN) involved in utilization review, you must complete a state-approved LPN educational program, pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN), and obtain licensure. Additional training or certification in case management or utilization review may enhance your qualifications for this specialized role.

What are the most commonly searched types of Lpn Utilization Review jobs in Raleigh, NC?

The most popular types of Lpn Utilization Review jobs in Raleigh, NC are:

What are popular job titles related to Lpn Utilization Review jobs in Raleigh, NC?

For Lpn Utilization Review jobs in Raleigh, NC, the most frequently searched job titles are:

What job categories do people searching Lpn Utilization Review jobs in Raleigh, NC look for?

The top searched job categories for Lpn Utilization Review jobs in Raleigh, NC are:

What cities near Raleigh, NC are hiring for Lpn Utilization Review jobs?

Cities near Raleigh, NC with the most Lpn Utilization Review job openings:

Lpn Utilization Review jobs near you
Infographic showing various Lpn Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 12% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $60,402 per year, or $29 per hour.

Utilization Management Nurse

Chapel Hill, NC • Remote

Brighton Health Plan Solutions, LLC
201 - 500 employees
Learn more about Brighton Health Plan Solutions, LLCexternal

Full-time

Re-posted 20 days ago

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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