Utilization Review Nurse-LVN/LPN

Location: Remote, United States. Schedule: Monday–Friday, 8:00 AM–5:00 PM Pacific Time, with rotating Saturday coverage as required.

Salary: $25–$30 per hour, depending on location, skills, and experience.

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

• Conduct first-level reviews of outpatient, ancillary, inpatient, behavioral health, skilled nursing, rehabilitation, and post-service requests.
• Determine medical necessity and benefit eligibility using clinical guidelines, medical policies, and plan documents.
• Refer denial authorizations, out-of-guideline cases, and complex requests to medical directors, independent review organizations, or senior care consultants.
• Support hospital discharge planning, transitions to the next level of care, and redirection to PPO providers.
• Process appeals and complete non-certification letters when appropriate.
• Document reviews confidentially in Eldorado/Episodes while meeting productivity, quality, and turnaround-time expectations.

Requirements

• Current LVN license in the United States or a U.S. territory.
• At least 1 year of clinical experience.
• Knowledge of medical claims and ICD-10, CPT, and HCPCS coding.
• Proficiency with Microsoft Word, Excel, PowerPoint, and Outlook.
• Strong verbal and written communication skills, including the ability to explain complex information clearly.
• Availability for 8:00 AM–5:00 PM Pacific Time and rotating Saturday coverage as required.

Culture & Benefits

• Competitive base salary with full benefits effective on the first day.
• 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 supporting diverse perspectives.