Utilization Review Nurse LVN

To ensure timely and accurate care decisions, the full-time Utilization Review Nurse LVN/LPN will perform clinical reviews for medical necessity and benefit coverage, applying clinical guidelines and maintaining compliance in a remote work environment. Key responsibilities Evaluate requests for medical necessity and appropriate level of care to ensure compliance and timely decisions Conduct first-level reviews across various care settings, including outpatient and inpatient requests Document decisions and escalate complex cases to senior staff or the Medical Director as needed 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 experience in utilization review or utilization management preferred Ability to interpret medical records and apply evidence-based criteria