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Utilization Review Nurse Lvn Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Active RN license (Nevada) * 5+ years acute care nursing experience * 3+ years Utilization Review experience * 3+ years discharge planning experience (acute care) * Experience with InterQual (must be ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Sutter Health

Utilization Review Tech III

San Mateo, CA · On-site

$48.91 - $68.47/hr

Graduate of an accredited Vocational Nursing Program * OR Other: Graduate of an accredited Psychiatric Technician Program CERTIFICATION & LICENSURE : * LVN-Licensed Vocational Nurse * OR PSYT ...

Personify Health

Utilization Review Nurse - LVN / LPN

$25 - $31/hr

Your accuracy and pace are what keep the entire utilization review process trustworthy. Schedule ... Current LVN license in the United States or a U.S. territory * 1+ years of clinical experience ...

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Utilization Review Nurse Lvn information

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How much do utilization review nurse lvn jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for utilization review nurse lvn in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a utilization review nurse LVN?

Utilization Review Nurse LVNs are Licensed Vocational Nurses who specialize in reviewing medical records and patient care to ensure that healthcare services are medically necessary and efficiently delivered. They assess treatment plans, verify insurance coverage, and work with healthcare providers to ensure appropriate care while minimizing unnecessary costs. Their role is crucial in maintaining compliance with healthcare regulations and optimizing patient outcomes.

How does a utilization review nurse LVN typically collaborate with physicians and insurance companies during the review process?

A Utilization Review Nurse LVN regularly communicates with physicians to clarify clinical documentation and ensure that patient care meets established guidelines. They also work closely with insurance companies by providing necessary medical information to justify the need for certain treatments or hospital stays. This collaboration ensures that patients receive appropriate care while maintaining compliance with payer requirements. The role requires strong communication skills and attention to detail, as accurate and timely information exchange is critical for successful case resolution.

What are the key skills and qualifications needed to thrive as a utilization review nurse LVN, and why are they important?

To thrive as a Utilization Review Nurse LVN, you need a current LVN license, strong clinical judgment, and a foundational understanding of healthcare regulations and medical necessity criteria. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance authorization processes are typically required. Excellent communication, critical thinking, and attention to detail are essential soft skills for effectively collaborating with providers and advocating for patients. These skills are vital to ensure appropriate resource utilization, promote quality care, and support compliance with payer and regulatory guidelines.

What is the difference between Utilization Review Nurse Lvn vs Utilization Review Nurse RN?

AspectUtilization Review Nurse LvnUtilization Review Nurse RN
CredentialsLicensed Vocational Nurse (LVN/LPN)Registered Nurse (RN)
Work EnvironmentHospitals, clinics, insurance companiesHospitals, insurance companies, outpatient facilities
Job ResponsibilitiesReview patient cases, assess medical necessity, document findingsPerform detailed case reviews, coordinate care, make complex decisions

Utilization Review Nurse Lvn and Utilization Review Nurse RN both work in healthcare settings reviewing patient cases for insurance or medical necessity. RNs typically have broader responsibilities and more advanced training, but LVNs are qualified to perform many review tasks under supervision. The main differences lie in credentials, scope of practice, and complexity of case management.

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Utilization Review Nurse Lvn jobs near you
Infographic showing various Utilization Review Nurse Lvn job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

RN Utilization Review-Crestwood Medical Center-FT-1st shift

Huntsville Hospital Health System

Huntsville, AL

Full-time

Re-posted 10 days ago

Huntsville Hospital Health System rating

6.2

Company rating: 6.2 out of 10

Based on 208 frontline employees who took The Breakroom Quiz

698th of 893 rated healthcare providers

Job description

Overview

Utilization management is the analysis of the medical necessity, acute care appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate, but ensures that an authorization for services is obtained from payer, if required, and that documentation supports the care delivered in such a way that minimizes the risk of denials after discharge.

Qualifications

Required Education: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse

Preferred Education: Bachelors Science Nursing or higher

Required Experience: 2 years previous nursing experience

Preferred Experience: Utilization Review or Case Management experience

Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse

Preferred License/Registration/Certification: ACM or CCM Certification

Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, Microsoft Suite and email applications.

Employment Type: OTHER

What Huntsville Hospital Health System employees say

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Benefits

Hours and flexibility

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