Remote Utilization Management Nurse (LPN/LVN)

Integra Partners; Columbus (OH); Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

Competitive pay

401(k) Match

Life Insurance

Short-term Disability

Medical Vision Dental

Floating holidays

Remote Work

Job summary

Integra Partners in the United States is seeking a licensed nurse to perform pre-service and post-service UM authorization reviews, applying federal and state mandates and medical criteria to determine medical necessity.

You will approve eligible requests, refer non-qualifying cases to Medical Director, handle appeals, and help ensure compliance with NCQA, CMS, and state standards while benefiting from remote work options.

Qualifications

• Active LPN or LVN license in good standing.
• At least 3 years of nursing experience in acute or outpatient care.
• Minimum 2 years in utilization management within a managed care environment.
• Experience with InterQual, CMS guidelines or payer policies.
• Experience drafting denial letters is a plus.

Responsibilities

• Conduct pre-service and post-service UM authorization reviews per federal/state rules.
• Assess plan benefits, language, and criteria for medical necessity.
• Approve requests that meet eligibility and medical necessity.
• Refer non-qualifying cases to Medical Director for review.
• Process appeals and coordinate with Medical Director as needed.
• Maintain compliance with NCQA, CMS and State standards.

Skills

LPN/LVN License

UM Experience

Medical Necessity Criteria

Education

LPN/LVN Diploma

Job description

Integra Partners in the United States is seeking a licensed nurse to perform pre-service and post-service UM authorization reviews, applying federal and state mandates and medical criteria to determine medical necessity.

You will approve eligible requests, refer non-qualifying cases to Medical Director, handle appeals, and help ensure compliance with NCQA, CMS, and state standards while benefiting from remote work options.