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Remote Lpn Utilization Review Jobs in Raleigh, NC

Varsity Tutors

NCLEX-PN Tutor

Chapel Hill, NC · Remote

$18 - $40/hr

Adapts instruction using NCLEX-PN specific practice question banks, content review focused on practical nursing priorities, and clinical scenario practice to support LPN and LVN program graduates ...

Varsity Tutors

NCLEX Tutor

Chapel Hill, NC · Remote

$25 - $40/hr

... review resources, practice question banks, and clinical scenario analysis to support nursing graduates preparing for first-time licensure as registered nurses or licensed practical nurses.

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

Remote Lpn Utilization Review information

See Raleigh, NC salary details

$20

$41

$67

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

As of Jul 26, 2026, the average hourly pay for remote lpn utilization review in Raleigh, NC is $41.10, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.

Can an LPN make $50 an hour?

Remote LPN utilization review positions typically pay between $20 and $35 per hour, depending on experience and employer. Earning $50 an hour is uncommon for LPN roles, as they generally have lower salary ranges compared to RNs or specialized healthcare professionals. Higher wages may be available with additional certifications or in specialized or supervisory roles.

What kind of remote jobs can LPNs do?

Remote LPNs can work in roles such as utilization review nurses, telehealth nursing, case management, and patient education. These positions typically require strong communication skills, clinical knowledge, and sometimes certification in case management or telehealth tools, allowing them to perform assessments, coordinate care, and review patient records remotely.

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.

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.

How do I get into utilization review nursing?

To become a remote LPN in utilization review, you typically need to have an active Licensed Practical Nurse (LPN) license, relevant clinical experience, and knowledge of medical coding and insurance processes. Many employers also require familiarity with electronic health records (EHR) systems and strong communication skills. Certification in case management or utilization review can enhance job prospects and may be preferred by employers.

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.

Can an LPN be a utilization review nurse?

Yes, Licensed Practical Nurses (LPNs) can work as utilization review nurses, typically assisting with case assessments, documentation, and supporting clinical review processes. However, some employers may require additional certifications or experience in case management or utilization review to qualify for the role.
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Remote Lpn Utilization Review jobs near you
Infographic showing various Remote Lpn Utilization Review job openings in Raleigh, NC as of July 2026, with employment types broken down into 3% As Needed, 69% Full Time, 25% Part Time, and 3% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.
Utilization Management Nurse

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Posted 18 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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