Utilization Review Nurse I LVN/LPN (Fully Remote)

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

• 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.

What You Bring to Our Team:

• Graduate of an accredited LVN/LPN nursing program with a current U.S. license.
• 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.
• Competitive base salary and benefits effective day one.
• Comprehensive medical and dental through our own health solutions.
• Professional development with clear career progression and learning budgets.

Personify Health

Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. Their mission-driven culture empowers diverse perspectives to drive real impact on people's health.