Utilization Review Nurse

Utilization Review Nurse, LPNAcrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory requirements. This role reviews medical information submitted by treating providers, determines whether treatment can be authorized at the nurse level, and refers requests for physician review when additional clinical evaluation is required.This position is ideal for an experienced LPN with a strong clinical background who enjoys applying their medical knowledge in an analytical, process-driven environment. Experience in utilization review or case management is highly beneficial, particularly within workers' compensation. Clinical experience involving orthopedic or neurological conditions is also highly valued.This is a hybrid position with two days per week in the office and three days remote. Candidates must also have flexibility to periodically work a later schedule to support business needs across multiple time zones.Responsibilities:Review medical treatment requests and supporting clinical documentation for adherence to applicable state guidelines and utilization review requirementsApply clinical knowledge and established guidelines to determine whether treatment requests can be authorized at the nurse levelRefer treatment requests requiring additional clinical evaluation to physicians for reviewEvaluate medical records and treatment information to support timely and appropriate utilization review decisionsComplete required documentation and administrative processing throughout the utilization review processManage assigned reviews within applicable state-mandated and URAC turnaround requirementsAccurately document treatment requests, clinical information, review activity, and determinations within client recordsMaintain confidentiality of medical and client information in accordance with HIPAA and applicable standardsCollaborate with physicians, healthcare providers, claims professionals, and internal team members to facilitate the review processMaintain current clinical and industry knowledge relevant to utilization review and workers' compensationProvide responsive service while managing multiple reviews and competing deadlinesRequirements:Active LPN license requiredActive multistate/compact nursing license requiredStrong clinical nursing experience with the ability to review medical records and evaluate treatment requestsAbility to interpret medical terminology, treatment plans, and clinical documentationAbility to apply established clinical guidelines and determine when requests require physician reviewFlexibility to periodically work later hours to support business needs across multiple time zonesWorkers' compensation utilization review experience highly beneficialUtilization review or case management experience highly beneficialClinical experience involving orthopedic or neurological conditions strongly preferredStrong organizational skills with the ability to prioritize a high volume of time-sensitive reviewsStrong written and verbal communication skillsProficiency with Microsoft Office applications and ability to learn new clinical and claims systemsEducation and Licenses:Active Licensed Practical Nurse (LPN) license requiredActive multistate/compact nursing license requiredAdditional utilization review, case management, workers' compensation, or related professional certifications beneficialCandidates should be comfortable with an on-site presence to support collaboration, team leadership, and cross-functional partnership.At Acrisure, we're building more than a business, we're building a community where people can grow, thrive, and make an impact. Our benefits are designed to support every dimension of your life, from your health and finances to your family and future.Making a lasting impact on the communities it serves, Acrisure has pledged more than $22 million through its partnerships with Corewell Health Helen DeVos Children's Hospital in Grand Rapids, Michigan, UPMC Children's Hospital in Pittsburgh, Pennsylvania and Blythedale Children's Hospital in Valhalla, New York.We also offer our employees a comprehensive suite of benefits and perks, including:Physical Wellness: Comprehensive medical insurance, dental insurance, and vision insurance; life and disability insurance; fertility benefits; wellness resources; and paid sick time.Mental Wellness: Generous paid time off and holidays; Employee Assistance Program (EAP); and a complimentary Calm app subscription.Financial Wellness: Immediate vesting in a 401(k) plan; Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and employee discount programs.Family Care: Paid maternity leave and paid paternity leave (including for adoptive parents); legal plan options; and pet insurance coverage.… and so much more!This list is not exhaustive of all available benefits. Eligibility and waiting periods may apply to certain offerings. Benefits may vary based on subsidiary entity and geographic location.Acrisure is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, or protected veteran status. Applicants may request reasonable accommodation by contacting View email address on click.appcast.io candidates will be required to complete post-offer verification processes related to the role and in accordance with applicable laws.California Residents: Learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy.Recruitment Fraud: Please visit here to learn more about our Recruitment Fraud Notice.Welcome, your new opportunity awaits you.