Remote opportunity at
Integra PartnersUtilization Management Nurse - LPN/LVN
Integra Partners is seeking a remote Utilization Management Nurse (LPN/LVN) to join its team. Established in 2005, Integra Partners operates as a national network administrator specializing…
Career Tools
About This Role
Integra Partners is seeking a remote Utilization Management Nurse (LPN/LVN) to join its team. Established in 2005, Integra Partners operates as a national network administrator specializing in durable medical equipment, prosthetics, and orthotic supplies, working to connect payers, providers, and members for improved in-home healthcare access. In this full-time remote position, the LPN/LVN will conduct pre-service and post-service utilization reviews and handle appeals for DMEPOS items. The professional in this…
Job Description
Integra Partners is seeking a remote Utilization Management Nurse (LPN/LVN) to join its team. Established in 2005, Integra Partners operates as a national network administrator specializing in durable medical equipment, prosthetics, and orthotic supplies, working to connect payers, providers, and members for improved in-home healthcare access.
In this full-time remote position, the LPN/LVN will conduct pre-service and post-service utilization reviews and handle appeals for DMEPOS items. The professional in this role will collaborate directly with the Medical Director to execute medical necessity evaluations while ensuring alignment with NCQA-compliant utilization management programs.
This role is well-suited for licensed practical or vocational nurses who bring managed care payor background and an aptitude for fast-paced operational environments. Eligible applicants can reside in Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, or Washington.
Responsibilities
- Conduct pre-service and post-service utilization management authorization reviews using NCDs, LCDs, plan benefit language, and federal or state rules
- Partner with non-clinical staff members to gather necessary clinical documentation
- Grant approval for requests that satisfy medical necessity, eligibility, and benefit criteria
- Escalate cases failing medical necessity standards to the Medical Director
- Direct cases to independent review organizations or external consultants when required
- Deliver the outcomes of utilization management authorization reviews through verbal and written channels
- Handle clinical and administrative appeals, routing them to the Medical Director as appropriate
- Ensure ongoing adherence to standards set by state agencies, CMS, and accrediting bodies like NCQA
Requirements
- Hold an active Licensed Practical Nurse or Licensed Vocational Nurse license
- Bring a minimum of 3 years of nursing experience in an outpatient or acute care environment
- Have at least 2 years of utilization management experience within a managed care or payor setting
Qualifications
- Familiarity with Medicare and Medicaid
- Prior background handling utilization management authorizations and appeals for DMEPOS
- Experience applying Medical Necessity Criteria such as health plan medical policies, CMS guidelines, or InterQual
- Background in drafting denial letters
Core Skills
Benefits
- Competitive compensation paired with an annual bonus program
- 401(k) retirement plan featuring a company match
- Company-provided life insurance
- Company-sponsored short-term disability coverage
- Medical, dental, and vision insurance coverage
- Paid Time Off alongside sick time and parental leave
- Paid company holidays and floating holidays
- Access to health and wellness programs and quarterly sponsored events
- Career development pathways
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, this is a remote role with openings available for candidates residing in Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
What is the salary for this role?
The annual salary for this position is $60,000.00.
What licensing is required to apply?
Applicants must hold an active Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) license.
What level of experience is needed?
Candidates must have at least 3 years of nursing background in an outpatient or acute setting, plus a minimum of 2 years of utilization management experience within a managed care or payor environment.
Sample Interview Questions
AI-generated questions tailored to this specific role — a preview of the full practice set.