Temporary Utilization Review Nurse (LVN/LPN)

About the role

The Utilization Review Nurse (LVN/LPN) will evaluate medical records to determine the necessity of requested services, applying evidence‑based guidelines. This temporary position works Monday‑Friday during Pacific business hours and collaborates closely with the Medical Director and Nurse Case Manager.

Key responsibilities

• Receive and review referrals for medical appropriateness using MTUS, ACOEM, MCG, ODG and other recognized guidelines.
• Validate diagnoses, treatment plans, and corresponding care algorithms.
• Identify over‑utilization and negotiate with providers to amend or withdraw inappropriate requests.
• Refer non‑certification cases to peer clinical reviewers and arrange peer‑to‑peer contacts as needed.
• Maximize utilization of PPO/MPN networks and pre‑authorize inpatient and outpatient procedures.
• Communicate UR determinations to claims examiners, providers, attorneys, and other stakeholders within state‑specified timeframes, documenting decisions within 24 hours.

Required profile

• Experience in occupational medicine, orthopedics, or general medicine.
• Understanding of the workers’ compensation system.
• Ability to work Pacific Time Zone business hours.
• Strong attention to evidence‑based guidelines and clinical documentation.

Required skills

• Knowledge of MTUS guidelines.
• Knowledge of ACOEM guidelines.
• Knowledge of MCG guidelines.
• Knowledge of ODG guidelines.

What we offer

• Collaborative, people‑focused environment.
• Strong training and support from experienced medical leadership.
• Opportunities for career growth within a national risk‑management organization.