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Remote Lpn Utilization Review Jobs in Raleigh, NC

Varsity Tutors

NCLEX-PN Tutor

Raleigh, 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-PN Tutor

Durham, 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-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 ...

Senture

Medical Director

Raleigh, NC · Remote

While this position allows remote work, the individual must reside within the state of North ... Minimum three (3) years of experience supporting policy interpretation, utilization review ...

Centene

Psychologist Reviewer

Durham, NC · On-site +1

$87K - $157K/yr

... licenses as needed. Join Centene's mission-driven team as a Remote Psychologist Reviewer ... Interact with network practitioners to provide education on best practice models and utilization ...

Varsity Tutors

NCLEX Tutor

Durham, 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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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 Aug 20, 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.

What is a remote LPN utilization review?

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 does a remote LPN utilization review do?

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 are the key skills and qualifications needed for a remote LPN utilization review?

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 a remote LPN become a utilization review nurse?

A remote LPN can transition to a utilization review nurse role, but typically requires additional training or certification in utilization review, case management, or healthcare administration. Experience in clinical assessment and familiarity with medical records and coding are also beneficial for this career progression.

What kind of remote jobs can a licensed practical nurse do?

A licensed practical nurse (LPN) can work remotely in roles such as telehealth nursing, patient case management, and utilization review. These positions typically require strong communication skills, clinical knowledge, and often involve reviewing medical records or coordinating care from a remote setting.

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

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

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

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

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

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

Remote Lpn Utilization Review jobs near you
Infographic showing various Remote Lpn Utilization Review job openings in Raleigh, NC as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $85,491 per year, or $41.1 per hour.

Utilization Management Nurse

Brighton Health Plan Solutions, LLC

Chapel Hill, NC • Remote

Full-time

Re-posted 13 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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