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Remote Lpn Utilization Review Jobs in Nevada (NOW HIRING)

Pine Park Health

Patient Care Coordinator (Remote)

Reno, NV · Remote

$17.50 - $23/hr

This is a fully remote role -- you can work from home while making a real, daily difference in the ... N/LPN, CNA, Phlebotomist, Patient Care Technician, or similar) * Bachelor's degree strongly ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Las Vegas, NV · On-site +1

$51.50 - $62.75/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... pharmacist license in the U.S. * Experience: Prior managed care or utilization management ...

AristaMD

Referral Nurse Navigator (RNN)

Las Vegas, NV · On-site +1

$33 - $36/hr

FULLY REMOTE WITHIN CONTIGUOUS UNITED STATES SUMMARY: The RNN (Referral Nurse Navigator) is the ... Ensures all assigned sites are continually reviewed for eConsult referrals. * Follows up on all ...

Solid Rock Recruiting LLC

Remote Tax Manager

Las Vegas, NV · On-site +1

$135K - $195K/yr

Prepare and review: * Individual (1040), business (1120S, 1065), and basic corporate returns ... Active CPA license (required) * 5+ years of public accounting experience * Strong background in ...

Veterans Health Administration

Nursing Assistant

Reno, NV · On-site +1

$43.88K - $71.65K/yr

... licensed practical nurse, health technician, hospital corpsman, etc.), performing technical and ... Review our benefits Eligibility for benefits depends on the type of position you hold and whether ...

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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
Utilization Management Manager REMOTE Full Time

Utilization Management Manager REMOTE Full Time

ScionHealth

Las Vegas, NV • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

ScionHealth rating

6.0

Company rating: 6.0 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

726th of 864 rated healthcare providers

Job description

At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
Job Summary
The Utilization Management Manager plays a vital role in ensuring patients have timely access to care by managing both front-end prior authorizations and in-house concurrent review authorizations. This position blends strong relationship-building skills with clinical knowledge to navigate complex payer requirements, streamline the authorization process, and support seamless patient transitions.
From start to finish, this role drives the authorization process-reviewing prospective, retrospective, and concurrent medical records; coordinating with referring hospitals to secure prior authorizations; and partnering with case management teams at ScionHealth facilities to complete concurrent review authorizations. Acting as a navigator and liaison between Business Development, facility administration, managed care organizations, and payors, the specialist ensures determinations are communicated promptly and accurately to all relevant stakeholders.
By combining attention to detail with proactive collaboration, the Utilization Management Manager safeguards revenue integrity, reduces delays, and supports the organization's mission of delivering exceptional patient care. This role actively contributes to quality improvement, problem-solving, and productivity initiatives within an interdisciplinary model, demonstrating accountability and a commitment to operational excellence.
Essential Functions
  • Extrapolates and summarizes essential medical information to obtain authorization for admission and continued stay to/at ScionHealth Level of Care.
  • Prepares recommendations to sumbit timely request for reconsideration of denial determination in attempt to have denied authorization requests overturned.
  • Ensures authorization requests are processed timely to meet regulatory timeframes.
  • Reviews medical necessity assessments completed by case management, evaluating documentation for specific criteria related to severity of illness, and level of care appropriateness.
  • Generates written appeals to medical necessity-based payor denials for denials prior to admission and concurrent review authorizations. Appeal letters may be processed on behalf of the physician, combining clinical and regulatory knowledge in efforts to have consideration of authorization.
  • Documents authorization information in relevant tracking systems.
  • Effectively builds relationships with business development team, admissions team/clinical staff and managed care team, to coordinate the patient admission functions in keeping with the mission and vision of the hospital.
  • Supports review of patient referral for clinical and financial approval and/or escalation to leadership for approval following the Care Considerations grid.
  • Coordinates and facilitates pre-admission Prior Authorizations for patients from the referral sources:
    • Identifies /reviews medical record information needed from referring facility.
    • Applies appropriate clinical guidelines to pre-authorization determination process.
    • Communicates specific patient needs for equipment, supplies, and consult services as related to prior authorization requirements.
    • Acts as a liaison with the Business Development team through every stage of the authorization process through determination.
    • Initiates appeals process as appropriate.
    • Facilitates and coordinates physician-to-physician communication as appropriate to support the denial management process.
    • Communicates to appropriate teams, including business development and facility administration when clinical authorization and financial approval is complete, following standard authorization process.
  • Provides hospital team with needed prior authorization information on pending / new admissions.
  • Coordinate with managed care payor on all coverage issues and supports the LOA process as requested.
  • Coordinates and facilitates Concurrent Review Authorizations for patients actively in-house at a ScionHealth facility
    • Identifies /reviews medical record information needed from facility.
    • Applies appropriate clinical guidelines to concurrent review authorization process.
    • Review medical necessity review information provided by the case management team and communicates any additinoal questions or information requests
    • Acts as a liaison with the Case Management team through every stage of the concurrent review authorization process through determination.
    • Initiates appeals process as appropriate.
  • Communicates with Medical Advisors or case managers of managed care company as necessary; including during Care Coordination / Managed Care calls
  • Maintains a knowledge of areas of responsibility and develops and follows a program of continuing education.
  • Participates in continuing education/ professional development activities.
  • Learns and develops full knowledge of the CAAT Admission Processes and actively seeks to continuously improve them.

Knowledge/Skills/Abilities/Expectations
  • Strong relationship building skills and a spirit to serve to ensure effective communication and service excellence.
  • Knowledge of regulatory standards and compliance guidelines.
  • Working knowledge of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare and Medicaid rules, regulations, coverage guidelines, NCDs and LCDs.
  • Working knowledge of Medicare, Medicaid and Managed Care payment and methodology.
  • Extensive knowledge of clinical symptomology, related treatments and hospital utilization management.
  • Excellent interpersonal, verbal and written skills to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers.
  • Critical thinking, problem solving, and decision-making capabilities with the ability to discern, collect, organize, evaluate, and communicate pertinent clinical information with effective verbal and written skills.
  • Technical writing skills for appeal letters and reports.
  • Effective time management and prioritization skills.
  • Computer skills with working knowledge of Microsoft Office (Word, Excel, PowerPoint, and Outlook), word-processing and spreadsheet software.
  • Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
  • Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
  • Communicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and others.
  • Adheres to policies and practices of ScionHealth.
  • Must read, write, and speak fluent English
  • Must have good and regular attendance.
  • Approximate percent of time required to travel: N/A

Pay Range: $66,700-$100,500/yr
ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.
Qualifications
Education
  • Postsecondary non-Degree (Cert/Diploma/Program Grad) of an Accredited School of Nursing required
  • Associate's Degree in healthcare or related field required
  • Bachelor's Degree in healthcare or related field preferred
  • Equivalent combination of Education and/or Experience in lieu of education (3+ years in a related field) may be considered.

Licenses/Certifications
  • Healthcare professional licensure preferred.
  • In lieu of licensure, 3+ years of experience in relevant field required.
  • Some states may require licensure or certification.

Experience
  • 3+ years of experience in a healthcare strongly preferred.
  • Experience in managed care, case management, utilization review, or discharge planning a plus.

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