About the job
Utilization Management LVN (Remote)
We’re hiring a Licensed Vocational Nurse (LVN) to support our Utilization Management (UM) team in a fully remote role. This position plays a key part in conducting medical necessity reviews, coordinating authorizations, and ensuring appropriate utilization of healthcare services in line with established clinical guidelines. If you have strong clinical judgment, a sharp eye for detail, and thrive in a collaborative environment, we’d love to hear from you.
What You’ll Do
- Conduct prospective, concurrent, and retrospective reviews to assess medical necessity and appropriateness of care
- Apply MCG or InterQual criteria to clinical documentation
- Process prior authorization requests and determine appropriate levels of care
- Collaborate with RNs, physicians, and other clinical staff to support timely and accurate reviews
- Communicate determinations to providers and members in a clear, professional manner
- Maintain accurate documentation of reviews, decisions, and communication in the system
- Escalate cases that do not meet guidelines to appropriate reviewers
- Ensure compliance with regulatory and accreditation requirements (NCQA, CMS, and state-specific guidelines)
- Participate in team meetings, trainings, and quality audits
- Support other projects or initiatives as needed
What You’ll Bring
- Active and unrestricted LVN license in an eNLC (Enhanced Nurse Licensure Compact) state
- 3+ years of Nursing experience
- 1+ year of Utilization Management experience
- Knowledge of UM guidelines, medical terminology, and clinical documentation standards
- Comfortable using Microsoft Office and working within EMR or healthcare systems
- Highly organized and self-motivated with strong time management skills
- Excellent verbal and written communication skills