LVN Utilization Review Nurse

Job Summary

To ensure timely and accurate care decisions, the full-time LVN Utilization Review Nurse will perform clinical reviews for medical necessity and benefit coverage, applying clinical guidelines and policies while working Monday to Friday with rotating Saturday coverage.

Key responsibilities

• Conduct clinical reviews to evaluate medical necessity and appropriate levels of care
• Deliver first-level reviews across various care settings, including outpatient and inpatient requests
• Prepare thorough documentation for Medical Director review, ensuring compliance with established standards

Required qualifications

• Graduate of an accredited nursing program (LVN/LPN)
• Current, unrestricted U.S. or U.S. territory nursing license
• Minimum 1-2 years of recent clinical experience in acute care or relevant settings
• Prior utilization review or utilization management experience preferred
• Ability to interpret medical records and apply evidence-based criteria