Remote LPN: Medical Review & Utilization Specialist

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

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.