Remote Case Management Analyst (LPN/LVN) – TN, IL, TX, OK, NM, MT

Case Management Analyst (LPN)
Pay Rate: $27–30/hour
Location: Fully Remote (Must reside in TN, IL, TX, OK, NM, or MT)
Schedule: 5 days/week – Either 5/8-hour shifts or 4/10-hour shifts
Weekend Requirement: Must work one weekend day every week (set alternate schedule)
Assignment Length: 6 months (potential for extension or conversion based on performance, attendance, and business need)
Target Start Date: ASAP (pending onboarding completion)
Benefits: Health, Dental, Vision

About the Role

We are seeking a Licensed Practical Nurse (LPN) with insurance or managed care experience to join our team as a Case Management Analyst. In this fully remote role, you will conduct pre-authorization and utilization reviews to determine medical necessity and appropriateness of treatment plans using medically accepted and evidence-based criteria. This role supports quality care delivery while ensuring compliance with medical contracts and regulatory guidelines.

Key Responsibilities

• Conduct pre-authorization reviews in accordance with medical contracts and regulatory requirements
• Perform utilization review to validate medical necessity and appropriateness of services
• Review clinical documentation using Medicare and evidence-based criteria
• Evaluate treatment plans based on patient-specific clinical needs
• Ensure compliance with HIPAA, corporate integrity, diversity principles, and departmental policies
• Maintain productivity standards aligned with business needs
• Communicate effectively with internal teams, providers, and external customers
• Maintain confidentiality of sensitive company and patient information
• Participate in special projects and provide updates to management as needed

Qualifications

• Active, valid, unrestricted LPN license in state of residence (compact/multi-state licensure required if applicable)
• Clinical experience in Home Health and Durable Medical Equipment (DME)
• Experience in Utilization Review (UR) or Utilization Management (UM)
• Medicare utilization management experience preferred
• Strong clinical review skills with ability to apply appropriate medical criteria
• Customer-service oriented with strong verbal and written communication skills
• Strong interpersonal skills and ability to work collaboratively
• Proficiency with PC applications and database systems

  **Upon acceptance of offer, candidates will be required to submit to a background check, education and employment verification and urinalysis drug screen**

  #TMCS