Utilization Review Nurse I (LVN/LPN) - Care Decisions

Personify Health, Inc.; United States; Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical and dental benefits

Career development

Job summary

Personify Health seeks a licensed LVN/LPN to evaluate medical necessity, level of care, and coverage for diverse patient cases. You will review outpatient, inpatient, and post-service requests, ensuring accurate determinations across care settings.

You will escalate complex cases for advanced review and coordinate with IRO referrals. The role emphasizes rapid learning, collaboration, and impactful patient navigation within health plans.

Qualifications

• Must have a valid U.S. nursing license (LVN/LPN).
• 1–2 years of recent clinical experience in acute care, med-surg, ICU/ED, or similar.
• Working knowledge of MCG, NCCN, and UM documentation systems.

Responsibilities

• Evaluate requests for medical necessity, appropriate level of care, and benefit coverage.
• Review outpatient, inpatient, and post-service requests across care settings.
• Escalate cases that need advanced review and support IRO referrals.

Skills

LPN/LVN License

Clinical experience

UM documentation systems

Education

LVN/LPN Nursing Program

Tools

MCG

NCCN

UM documentation systems

Job description

Personify Health seeks a licensed LVN/LPN to evaluate medical necessity, level of care, and coverage for diverse patient cases. You will review outpatient, inpatient, and post-service requests, ensuring accurate determinations across care settings.

You will escalate complex cases for advanced review and coordinate with IRO referrals. The role emphasizes rapid learning, collaboration, and impactful patient navigation within health plans.