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Remote Lpn Utilization Review Jobs in Nevada (NOW HIRING)

Molina Healthcare

Medical Review Nurse (RN)

Las Vegas, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... License must be active and unrestricted in state of practice. * Experience demonstrating knowledge ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... License must be active and unrestricted in state of practice. * Experience demonstrating knowledge ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... License must be active and unrestricted in state of practice. * Experience demonstrating knowledge ...

Molina Healthcare

Medical Review Nurse (RN)

Las Vegas, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... License must be active and unrestricted in state of practice. * Experience demonstrating knowledge ...

Molina Healthcare

Medical Review Nurse (RN)

Mesquite, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... License must be active and unrestricted in state of practice. * Experience demonstrating knowledge ...

Pine Park Health

Remote Registered Nurse (RN)

Reno, NV · Remote

Act as a support system and escalation point for LVNs/LPNs/MAs within the team, enhancing our team ... Strong experience in remote roles, showcasing proficiency with technology and digital communication ...

Pine Park Health

Remote Registered Nurse (RN)

Reno, NV · Remote

Act as a support system and escalation point for LVNs/LPNs/MAs within the team, enhancing our team ... Strong experience in remote roles, showcasing proficiency with technology and digital communication ...

Pine Park Health

Remote Registered Nurse (RN)

Reno, NV · On-site +1

Act as a support system and escalation point for LVNs/LPNs/MAs within the team, enhancing our team ... Strong experience in remote roles, showcasing proficiency with technology and digital communication ...

CVS Health

Case Manager, Registered Nurse

Carson City, NV · Remote

$54.10K - $155.54K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

CVS Health

Case Manager, Registered Nurse

Carson City, NV · Remote

$54.10K - $155.54K/yr

Position Summary This is a remote work from home role anywhere in the US with virtual training ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

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How much do remote lpn utilization review jobs pay per hour?

As of May 28, 2026, the average hourly pay for remote lpn utilization review in Nevada is $43.06, according to ZipRecruiter salary data. Most workers in this role earn between $34.04 and $49.42 per hour, depending on experience, location, and employer.

What is a Remote LPN Utilization Review job?

A Remote LPN Utilization Review job involves evaluating medical records and healthcare services to ensure they meet established guidelines for medical necessity, appropriateness, and cost-effectiveness. Licensed Practical Nurses (LPNs) in this role review patient cases, collaborate with healthcare providers, and apply clinical knowledge to determine coverage decisions. They typically work for insurance companies, hospitals, or healthcare organizations, ensuring compliance with policies and regulations. This job is performed remotely, allowing LPNs to work from home while using electronic health records and digital communication tools. Strong analytical skills, attention to detail, and knowledge of medical coding and insurance policies are important in this role.

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

To thrive as a Remote LPN Utilization Review nurse, you need a valid LPN license, strong clinical assessment abilities, and a solid understanding of medical terminology and healthcare protocols. Familiarity with utilization review software, electronic health records (EHR), and sometimes certification such as CPUR (Certified Professional in Utilization Review) is valuable. Excellent organizational skills, attention to detail, and effective written and verbal communication set standout candidates apart. These abilities are crucial for making accurate medical necessity determinations, collaborating remotely, and ensuring compliance with healthcare regulations.

What does a typical day look like for a Remote LPN Utilization Review nurse?

A typical day for a Remote LPN Utilization Review nurse involves reviewing medical records, evaluating patient care for medical necessity and appropriate levels of service, and documenting findings in various systems. You’ll frequently collaborate with physicians, case managers, and other healthcare professionals via phone or email to clarify care plans or obtain additional clinical information. Many roles are structured to offer autonomous work within a supportive virtual team, and performance is often measured by accuracy, productivity, and adherence to deadlines. This position offers the opportunity to develop a deep understanding of healthcare delivery systems and can be a stepping stone to advanced roles in case management or quality assurance.
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Remote Lpn Utilization Review jobs near you
Medical Review Nurse (RN)

Medical Review Nurse (RN)

Molina Healthcare

Las Vegas, NV • Remote

$30.50 - $59.47/hr

Full-time

Posted 21 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

147th of 258 rated insurance

Job description

Job Description

Job Summary

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. 

 
Job Duties
  • Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. 
  • Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions.
  • Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. 
  • Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues.
  • Identifies and reports quality of care issues.
  • Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
  • Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings.                                                                   
  • Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. 
  • Supplies criteria supporting all recommendations for denial or modification of payment decisions.
  • Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. 
  • Provides training and support to clinical peers. 
  • Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
 
Job Qualifications
REQUIRED QUALIFICATIONS:
  • At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. 
  • Registered Nurse (RN) in Nevada. License must be active and unrestricted in state of practice. 
  • Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC).
  • Experience working within applicable state, federal, and third-party regulations.
  • Analytic, problem-solving, and decision-making skills.              
  • Organizational and time-management skills.
  • Attention to detail.
  • Critical-thinking and active listening skills. 
  • Common look proficiency.
  • Effective verbal and written communication skills.
  • Microsoft Office suite and applicable software program(s) proficiency.
PREFERRED QUALIFICATIONS:
  • Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
  • Utilization Management Experience
  • Experience with MCG, PEGA and/or Salesforce  
  • Billing and coding experience.
 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.  
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $30.5 - $59.47 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

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Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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