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Lvn Utilization Review Jobs (NOW HIRING)

Wesley Medical Center

RN - Utilization Review

Tuba City, AZ · On-site

$2.5K/wk

  • Medical

  • Dental

  • Vision

  • Retirement

You must have a Nursing License and at least 2 years of recent Utilization Review US nursing experience as a RN - Utilization Review. Prime`s team of experienced health care professionals are here to ...

Hired by Matrix

RN Utilization Review

Tuba City, AZ · On-site

Day 5x8-Hour (08:00 - 16:30) Weekly Schedule: 40 Hours Certifications/License: Mandatory Experience: * RN Utilization Review * Shift: Monday - Friday from 8am - 5pm. Callback on weekends/holidays

talent4health

RN - Utilization Review

Cleveland, OH · On-site

$2.2K/wk

... Utilization Review Job ID 18807560 Job Title RN - Utilization Review Weekly Pay $2214.0 Shift ... Current licensure by Ohio State Board of Nursing. * Minimum of five (5) years recent experience in ...

Nexus Enterprises

DFW Pre-Cert Nurse/UR Nurse

Fort Worth, TX · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

PreCert Nurse - LVN Utilization Review Nurse (Administrative Nursing) Are you looking for a challenging and impactful nursing career that will diversify your nursing skills? Tired of working long ...

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Lvn Utilization Review information

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$48

How much do lvn utilization review jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for lvn utilization review in the United States is $31.85, according to ZipRecruiter salary data. Most workers in this role earn between $26.44 and $35.58 per hour, depending on experience, location, and employer.

What is an LVN Utilization Review?

LVN Utilization Review nurses are Licensed Vocational Nurses who specialize in evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and help ensure that treatments meet established guidelines and insurance requirements. By assessing the quality and cost-effectiveness of care, they play a vital role in managing healthcare resources and supporting patient advocacy.

What are some common challenges faced by LVNs in Utilization Review positions, and how can they be managed?

LVNs in Utilization Review often encounter challenges such as balancing clinical knowledge with administrative tasks, adapting to evolving insurance guidelines, and managing high caseloads. Navigating frequent policy updates and documentation requirements can be demanding, but staying organized and proactively communicating with healthcare teams helps maintain efficiency. Utilizing available training resources and collaborating closely with RNs, physicians, and insurance representatives can also ease the transition and support professional growth in the role.

What is the difference between Lvn Utilization Review vs Lvn Case Manager?

AspectLvn Utilization ReviewLvn Case Manager
CertificationsLicensed Vocational Nurse (LVN)Licensed Vocational Nurse (LVN)
Work EnvironmentReviewing medical records, insurance, and treatment plans in office or hospital settingsCoordinating patient care, communicating with providers and families, often in clinical or home settings
Employer & IndustryInsurance companies, healthcare facilities, utilization review organizations

While both roles require LVN licensure, Lvn Utilization Review focuses on evaluating medical necessity and reviewing records, whereas Lvn Case Managers actively coordinate patient care and support treatment plans. The roles differ mainly in daily responsibilities but share similar credentials and work environments.

What are the key skills and qualifications needed to thrive as an LVN Utilization Review nurse?

To thrive as an LVN Utilization Review nurse, you need a strong clinical background, current LVN licensure, and knowledge of medical terminology and care standards. Familiarity with utilization management software, electronic health records (EHRs), and insurance guidelines is typically required. Strong analytical skills, attention to detail, and effective communication are vital soft skills for collaborating with healthcare teams and ensuring accurate reviews. These skills ensure that patient care is both appropriate and cost-effective while maintaining compliance with regulatory and payer requirements.
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Lvn Utilization Review jobs near you
Infographic showing various Lvn Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $66,243 per year, or $31.8 per hour.

PreCert Nurse/Utilization Review Nurse

Nexus Enterprises

San Antonio, TX • On-site

Full-time

Medical, Dental, Vision, Life, PTO

Re-posted 24 days ago

Job description

Multiple work schedules, Monday - Friday!
Eligible to enroll in Medical plan on date of hire!
LVN or RN Utilization Review Nurse (Administrative Nursing)
Are you looking for a challenging and impactful nursing career that will diversify your nursing skills? Tired of working long hours and standing on your feet all day? Want to have work-life balance? If you enjoy working in a positive environment, Nexus has the solution for you with an exciting nurse administrative role! If this sounds like the kind of career move for you to make, we want to talk with you!
ABOUT THE COMPANY:
Nexus is dedicated to connecting quality healthcare professionals with the outcome needs of our partners in the health, insurance, and legal industries. The heart of our drive for quality and excellence rests in our unflinching integrity; we bend over backwards to provide the best possible service but will never bend our integrity. Nexus realizes that behind the paperwork and reports, there are people: mothers, fathers, sisters, brothers, sons, and daughters. These are people in need of the best, most accurate, medical care possible and we are tasked with ensuring they receive it in an efficient and cost-effective manner. We offer competitive compensation and fantastic benefits, as well as a collegial workplace in a casual dress environment. We encourage professional development and advancement as you learn our unique utilization management solutions.
WHAT WE LOOK FOR:
Our ideal candidate is a highly motivated and dynamic individual that thrives in a fast-paced research-oriented environment. Someone who is willing to learn and grow in a different sector of the nursing field.
WHAT WORKING AT NEXUS IS LIKE:
  • Positive office environment, Monday through Friday, offering multiple work schedules and shift differential
  • On-site fitness center, showers, nursing mothers’ rooms, snack bar, state of the art lounge, ergonomic workspace, and filtered water refill stations
  • Exceptional benefits to include paid time off, health, dental, vision, disability, life insurance, holiday pay, parental leave, employee assistance and wellness programs
  • Incentive programs for high quality performance
  • Extensive training throughout the onboarding process
  • Excellent opportunities for professional growth and development
POSITION OVERVIEW:
The primary function of the PreCert Nurse is to effectively review and analyze medical records of patients in need of care and create executive reports that are submitted to a physician for review. Each executive report includes a summary, appropriate criteria/guidelines, and a rationale.
This position is located in Schertz, Texas.
What will be my duties and responsibilities?
  • Perform a review of services for medical appropriateness utilizing pre-approved criteria and guidelines to validate medical necessity/appropriateness of treatment (e.g., ODG, MTUS, Milliman Care Guidelines, InterQual)
  • Audit and analyze patient records to ensure quality patient care and necessity of services
  • Provide clinical knowledge and act as a clinical resource to non-clinical staff
  • Enter and maintain pertinent clinical information in various medical management systems
  • Maintain knowledge of regulatory requirements (i.e., URAC), and state utilization review standards
  • Use of clinical logic and reasoning to determine appropriate evidence-based guidelines
  • Facilitate cost effective and quality patient care by effective communication with managerial team, physicians, and Medical Director
What are the requirements needed for this job?
  • Excellent written and verbal communication skills
  • Ability to communicate professionally with physicians and clients
  • Ability to multi-task and quickly adapt in a fast-paced office environment
  • Strong organizational skills with attention to detail
  • Ability to problem solve complex, multifaceted, situations
  • Experience with Microsoft products: Word, Excel, PowerPoint, Outlook
  • Education, training or professional experience in medical and/or clinical practice
  • Current LVN/RN license, without restrictions, from an accredited vocational nursing program (LVN) or a degree in nursing (RN) from an accredited college
What other skills/experience are we looking for?
  • 3-5 years of clinical nursing experience (preferred)
  • Prior experience in Utilization Management (preferred)
  • Knowledge of ODG, MTUS, Milliman Care Guidelines, InterQual (preferred)

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