Utilization Review Nurse (LPN)

Location: Hybrid in Bradenton, Florida, with two days per week in the office and three days remote. Periodic later schedules are required to support business needs across multiple time zones.

Company

hirify.global is a global fintech company providing insurance, reinsurance, payroll, benefits, cybersecurity, mortgage, and related business solutions.

What you will do

• Review medical treatment requests and supporting documentation against state guidelines and utilization review requirements.
• Apply clinical knowledge to authorize treatment at the nurse level or refer requests to physicians for additional review.
• Evaluate medical records and treatment plans to support timely and appropriate decisions.
• Complete documentation, administrative processing, and accurate records of review activity and determinations.
• Manage multiple time-sensitive reviews within state-mandated and URAC turnaround requirements.
• Collaborate with physicians, healthcare providers, claims professionals, and internal stakeholders while maintaining HIPAA confidentiality.

Requirements

• Active Licensed Practical Nurse (LPN) license and active multistate/compact nursing license required.
• Strong clinical nursing experience, including the ability to review medical records and interpret medical terminology, treatment plans, and clinical documentation.
• Ability to apply established clinical guidelines and determine when physician review is required.
• Strong organization, prioritization, written communication, and verbal communication skills for managing a high volume of time-sensitive reviews.
• Proficiency with Microsoft Office and the ability to learn clinical and claims systems.
• Comfort with the required hybrid office presence and periodic later working hours.

Nice to have

• Workers' compensation utilization review experience.
• Utilization review or case management experience.
• Clinical experience involving orthopedic or neurological conditions.
• Utilization review, case management, workers' compensation, or related professional certifications.

Culture & Benefits

• Medical, dental, vision, life, and disability insurance.
• Paid sick time, paid time off, holidays, maternity and paternity leave, including adoption leave.
• 401(k) plan with immediate vesting, HSA, FSA, and commuter benefits.
• Fertility benefits, wellness resources, Employee Assistance Program, and Calm app subscription.
• Legal plan options, pet insurance, and employee discount programs.