LVN / Utilization Review Nurse (LOA Coverage) - Fully Remote

Position: LVN / Utilization Review Nurse

Location: Fully Remote

Employment Type: Temporary Assignment (LOA Coverage)

Pay Range: $25.00 – $40.00/HR, Paid Weekly

Schedule: Monday – Friday, Standard Business Hours

Position Summary: 

We are seeking a Licensed Vocational Nurse (LVN) to provide temporary Utilization Review (UR) support during a leave of absence. The Utilization Review Nurse is responsible for reviewing medical records and treatment requests to determine the medical necessity of services based on evidence-based guidelines and workers’ compensation regulations.

The UR Nurse evaluates treatment plans and medical documentation using established clinical guidelines such as MTUS, ACOEM, ODG, and MCG to determine whether requested medical services are appropriate for the injury and clinical history. This role works closely with the Medical Director, Nurse Case Managers, and claims teams to ensure timely and compliant utilization review decisions. Additional training will be provided.

Key Responsibilities: 

• Review medical records and treatment requests to determine medical necessity based on evidence-based guidelines and best practices.
• Identify diagnoses and evaluate treatment plans against appropriate care algorithms.
• Apply guidelines such as MTUS, ACOEM, MCG, ODG, and state-specific treatment standards during case review.
• Identify potential over-utilization and collaborate with providers when treatment modifications are appropriate.
• Refer cases requiring non-certification to physician peer reviewers.
• Coordinate peer-to-peer discussions between treating providers and reviewing physicians when necessary.
• Authorize appropriate inpatient and outpatient procedures.
• Communicate utilization review determinations to claims examiners, providers, attorneys, and other stakeholders within required regulatory timelines.
• Summarize medical records and present case recommendations to physician advisors or peer reviewers.
• Identify cases requiring medical case management and recommend referrals through the supervisor.
• Collaborate with clients, claims teams, nurse case managers, and supervisors to ensure effective case management.
• Support oversight of assigned non-clinical staff tasks when required.
• Assist with notification processes for treatment non-certifications issued by physician reviewers.

Required Qualifications: 

• Licensed Vocational Nurse (LVN)
• Minimum 3 years of clinical experience.
• Strong understanding of medical terminology and clinical documentation.
• Ability to manage multiple cases and priorities in a fast-paced environment.
• Strong organizational, time management, and communication skills.
• California Workers’ Compensation experience.
• Utilization Review or Managed Care experience.
• Familiarity with California Workers’ Compensation regulations.
• Completion of IEA CA10 certification within one year of employment.
• Strong attention to detail and analytical skills.
• Ability to multitask and adapt to changing priorities.
• Excellent organizational and time management skills.
• Ability to collaborate with providers, clients, and internal teams.
• Self-motivated with the ability to work independently in a remote environment.

Working Conditions:

• May on occasion be exposed to loud sounds and distracting noise levels, such as from office equipment.
• The ability to lift up to 30lbs.
• Use of computers and technology.

Here at Canon Recruiting, People are our priority, and we are committed to Include Diversity in every segment of who we are. It is only through our Diversity; we are made a stronger organization and increase our ability to provide top tier candidates that our clients have come to know Canon for. We have an inclusive environment all employees are celebrated for their unique differences. The different perspectives and experiences of our workforce give us the competitive advantage that is essential for success in an ever-changing market. By promoting inclusion with the same enthusiasm, we devote to quality and competency and using the experience from a diverse assortment of backgrounds and experiences, Canon can improve the services and value we deliver to clients, employees, and customers.

At Canon, Diversification and Inclusiveness are much more than a corporate ambition; they are a critical component in our daily corporate life. Canon Recruiting is committed to a diverse and inclusive workplace. Canon Recruiting is an equal opportunity employer and does not discriminate based on race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.

The pay range for this position is listed above. Base pay information is based on market location. We will consider for employment qualified applicants with arrest and conviction records. Our range of benefits may include health care and 401(k) savings plans. For individuals with disabilities who would like to request an accommodation, please email hr@canonrecruiting.com