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

Canon Recruiting Group•Santa Clarita, CA

2d•$25 - $40•Remote

About The Position

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.

Requirements

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.

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.