Remote Utilization Management Nurse (LPN/LVN)

Integra Partners

Michigan

Hybrid

USD 54,000 - 66,000

Full time

7 days ago

Be an early applicant

Application generator

Turn this role into an interview — a resume and cover letter built around what this employer wants.

Get past ATS filters

Benefits offered by this job

Annual bonus program

401(k) retirement program with company

Company-paid life insurance

Short term disability coverage

Medical, Vision, and Dental benefits

PTO

Paid Parental Leave

Sick Time

Holidays and floating holidays

Quarterly events

Wellness programs

Career development opportunities

Job summary

Integra Partners seeks an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals within a NCQA-compliant UM program. You will collaborate with our Medical Director on benefit and medical necessity reviews in a managed care payor environment.

The role requires active LPN/LVN licensure, at least 3 years of nursing experience, and 2+ years in UM. The position offers competitive compensation with comprehensive benefits and potential annual bonus.

Qualifications

3+ years nursing in acute or outpatient setting required.
2+ years UM experience in managed care/payor environment desired.
Familiarity with Medicare/Medicaid and UM authorizations helpful.
Strong written and verbal communication skills.

Responsibilities

Perform pre-service and post-service UM authorization reviews using mandates, plan benefits, and criteria for medical necessity.
Coordinate with non-clinical teams to obtain needed information.
Approve requests meeting eligibility, benefit, and medical necessity criteria.
Refer cases not meeting criteria to Medical Director or independent consultants.
Communicate outcomes of UM reviews both verbally and in writing.
Process administrative and clinical appeals and refer as needed.
Maintain NCQA CMS and state accrediting standards compliance.
Demonstrate strong organization, adaptability, and teamwork.
Perform other duties as assigned.