Utilization Review Nurse I LVN/LPN (Healthcare)

Location: Remote, United States

Salary: $25–$30 per hour, depending on location, skills, and experience. Full benefits begin on day one.

Company

hirify.global provides a personalized health platform combining health plan administration, wellbeing solutions, and care navigation for employers, health plans, and health systems.

What you will do

• Review prior authorizations, pre-certification requests, inpatient stays, post-service reviews, and post-claim cases for medical necessity, level of care, documentation completeness, and benefit coverage.
• Apply internal medical policies, plan-specific policies, MCG, and NCCN criteria in the utilization management system.
• Escalate cases outside guidelines or requiring adverse determinations to senior staff or the Medical Director, and support IRO referrals.
• Verify plan benefits and guide providers and members toward appropriate in-network or PPO options.
• Prepare complete case summaries and documentation for Medical Director review and regulatory audits.
• Meet productivity, quality, turnaround, HIPAA, URAC, and NCQA standards while supporting team coverage and training.

Requirements

• Graduate of an accredited nursing program with an LVN/LPN qualification.
• Current, unrestricted U.S. or U.S. territory nursing license required; a compact license is acceptable where applicable.
• At least 1–2 years of recent clinical experience in acute care, med-surg, ICU/ED, or a related setting.
• Ability to interpret medical records and apply evidence-based criteria and plan medical policies.
• Working knowledge of MCG, NCCN, utilization management documentation systems, and Microsoft Office tools.
• Ability to work with remote technology, VPNs, departmental platforms, multiple screens, and headset-based phone systems while maintaining accurate data entry.

Nice to have

• Previous utilization review or utilization management experience.

Culture & Benefits

• Competitive base salary and benefits effective from day one.
• Medical and dental coverage through hirify.global solutions.
• Paid time off, mental health support, retirement planning, and financial protection.
• Professional development, career progression, and learning budgets.
• Mission-driven environment focused on improving health outcomes and valuing diverse perspectives.