LPN - Medical Review - Remote

CEI; Columbia (SC); Hybrid; USD 26,000 - 37,000; Full time

Job summary

CEI is seeking an LPN to join a clinical review team handling utilization management across professional, inpatient/outpatient, and facility services. The role starts with onsite training in Columbia, SC, then transitions to remote work with periodic onsite meetings as needed.

You will apply established criteria and clinical guidelines to document determinations, support authorizations, and ensure timely, accurate decisions.

Qualifications

• Graduate of an accredited LPN/LVN program.
• Active LPN/LVN license required.
• Experience with utilization management or medical review workflows is preferred.

Responsibilities

• Perform medical reviews and utilization management using established criteria and guidelines.
• Review documentation for pre-certifications and determine determinations per protocol.
• Support authorization processes to confirm coverage and medical necessity within guidelines.
• Review medical information and interdepartmental requests to complete utilization workflows.
• Provide timely written communication to members and providers regarding determinations.
• Educate internal/external stakeholders on review processes and terminology.
• Participate in training and quality control activities to support team objectives.

Skills

Medical terminology

Clinical documentation review

Analytical thinking

Written communication

Confidential info handling

Team collaboration

Evidence-based guidelines

Education

LPN/LVN credential

Associate degree (preferred)

Job description

Back LPN - Medical Review - Remote
Healthcare Columbia , South Carolina Contract 100% Remote Nov 2, 2026

LPN - Medical Review

Job at a Glance

• Title: LPN - Medical Review
• Location: Columbia, SC (remote after 1–2 weeks of onsite training; local candidates only; onsite as needed for meetings/training)
• Contract: W2 only
• Pay: $ 23/hour + optional medical, dental, vision, 401(k) match
• Must live within 2 hours of Columbia, SC
• Must have an active LPN License

Overview

Join a clinical review team supporting utilization management and medical reviews for professional, inpatient/outpatient, facility services, and appeals. In this role, you will apply established criteria and clinical guidelines to document determinations, support authorizations, and ensure timely, accurate decisions. This is a contract opportunity with an initial onsite training period followed by remote work.

Key Responsibilities

• Perform medical reviews and utilization management using established criteria sets and clinical guidelines
• Review clinical documentation for pre-certifications (e.g., DME, home healthcare, elective procedures) and document determinations per protocol
• Support authorization processes to confirm coverage and medical necessity within benefit guidelines
• Review medical information and interdepartmental requests in a timely manner to complete utilization workflows
• Provide accurate, timely written documentation and communications to members and providers regarding determinations
• Educate internal/external stakeholders on medical review processes, medical terminology, and coverage/coding practices
• Participate in required training and quality control activities to support team and organizational objectives

Required Skills

• Strong understanding of medical terminology and clinical documentation review
• Ability to apply clinical guidelines/criteria sets to support coverage and medical necessity determinations
• Analytical and critical thinking skills with sound judgmentDemonstrated customer service, organization, and attention to detail
• Proficiency with word processing and computer-based workflows
• Strong written communication skills (spelling, punctuation, grammar)
• Ability to handle confidential and sensitive information with discretion
• Ability to adapt to changing workloads and collaborate in a supportive team environment

Education

• Graduate of an accredited school of Licensed Practical Nursing (LPN) / Licensed Vocational Nursing (LVN)

Preferred Skills

• Associate degree in Nursing OR graduate of an accredited school of Nursing
• Experience supporting utilization management, authorizations, or medical necessity review workflows
• Ability to educate peers or stakeholders on review processes and clinical documentation standards

Why Should I Apply?

If you enjoy applying clinical expertise to structured guidelines and delivering clear, well-documented determinations, this role offers a strong opportunity to contribute in a collaborative clinical review environment.

About CEI:

As a trusted technology partner, CEI delivers solutions that help our customers transform our customers from strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements.