Remote LVN Concurrent Review Nurse

Job Overview

Virelia Health connects healthcare professionals with opportunities across nursing, utilization management, managed care, and hospital review operations.

We are seeking qualified LVNs/LPNs for remote concurrent review opportunities supporting health plans, managed care organizations, and hospital utilization management teams.

A Remote LVN Concurrent Review Nurse reviews ongoing inpatient hospital stays to confirm that continued hospitalization meets established medical necessity criteria. Unlike prior authorization (which reviews services before they happen) or retrospective appeals (which look back at past denials), concurrent review happens in real time — while the patient is still in the hospital.

This position is well-suited to an LVN with acute care or hospital experience who enjoys clinical review, coordination with hospital case managers, and applying structured criteria to ongoing care.

The specific payer mix, criteria set (MCG or InterQual), technology, and scope of responsibilities will depend on the employer and assignment.

This opportunity may be suitable for professionals searching for remote LVN concurrent review jobs, remote concurrent review nurse, remote LPN utilization management, remote inpatient review nurse, work-from-home concurrent review LVN, or remote hospital utilization review nurse roles.

What You'll Do

As a Remote LVN Concurrent Review Nurse, you may support health plans and hospital UR teams with real-time inpatient stay reviews.

• Review inpatient admissions and continued-stay requests against MCG or InterQual criteria.
• Coordinate with hospital case managers, utilization review staff, and attending providers to gather clinical information.
• Apply established medical necessity criteria to determine whether continued hospitalization meets coverage requirements.
• Document review determinations, clinical rationale, and supporting information accurately.
• Escalate cases that do not meet criteria or require clinical judgment to an RN reviewer or physician advisor.
• Support discharge planning coordination by identifying barriers to timely discharge.
• Notify hospitals of coverage decisions within regulatory and contractual turnaround times.
• Identify cases that may benefit from transition-of-care support or care management.
• Maintain accurate records in the concurrent review platform or utilization management system.
• Track length of stay, level of care changes, and observation status reviews.
• Participate in inter-rater reliability reviews and quality calibration sessions.
• Follow regulatory requirements for Medicare, Medicaid, and commercial plans.
• Protect confidential member information and follow HIPAA requirements.

Concurrent Review Focus

Concurrent review is the real-time clinical review of hospitalized patients — determining whether continued inpatient care meets medical necessity criteria on an ongoing basis.

Depending on the program, concurrent review may involve:

The LVN's role is to apply established criteria and document review outcomes — not to independently determine coverage for complex cases. Cases requiring clinical judgment or physician review are escalated to an RN or medical director according to the employer's protocol.

This structure keeps the role focused on real-time review, hospital coordination, criteria application, documentation, and appropriate escalation.

Hospital & Provider Communication

Concurrent review is a fast-paced, relationship-driven process. Clear, professional communication with hospital staff is essential to keep reviews on track and prevent delays in coverage decisions.

You may communicate with:

• Hospital case managers and social workers.
• Hospital utilization review staff.
• Attending physicians and hospitalists.
• RN and physician reviewers within the health plan.
• Post-acute care coordinators and discharge planners.
• Skilled nursing facilities, home health agencies, and rehab centers when coordinating post-acute transitions.

Communication should be factual, efficient, and aligned with the criteria and regulatory framework in use.

Review & Escalation

A Remote LVN Concurrent Review Nurse may follow a structured workflow for each case.

Depending on the employer's protocols, you may:

Required Qualifications

• Current LPN or LVN license applicable to the specific assignment.
• Nursing education appropriate for LPN/LVN practice.
• Clinical nursing experience in acute care, hospital, or managed care settings.
• Familiarity with MCG or InterQual criteria and inpatient medical necessity review.
• Strong clinical documentation review skills.
• Comfortable communicating with hospital staff, case managers, and providers.
• Strong written and verbal communication skills.
• Comfortable using computers, EHR systems, and utilization management platforms.
• Ability to manage high case volume and meet regulatory deadlines.
• Strong attention to detail and audit-readiness.
• Ability to recognize situations requiring escalation.
• Ability to work independently in a remote environment.
• Ability to maintain confidentiality when handling member information.

Preferred Qualifications

Experience in any of the following may be beneficial:

Skills & Competencies

Concurrent Review & Clinical Skills

Managed Care & Hospital Knowledge

Documentation & Technology

Professional Skills

A Typical Day

A typical day may begin by reviewing the hospital admission list and identifying patients due for initial or continued-stay review.

You may then contact hospital case managers to gather updated clinical information — diagnosis, current treatment plan, anticipated discharge date, and progress toward discharge criteria.

You'll apply MCG or InterQual criteria to determine whether continued stay is medically necessary, document your findings clearly, and notify the hospital of the coverage decision within the required timeframe.

Some cases may require escalation to an RN reviewer or physician advisor when criteria are not clearly met or clinical judgment is needed.

You may also support discharge planning coordination — helping identify barriers that could delay timely discharge.

The role combines real-time clinical review, hospital communication, criteria application, documentation, and coordination with care teams.

Unlike bedside nursing, concurrent review is performed during business hours with a structured workflow and clear regulatory deadlines.

Remote Work Environment

This position is designed for remote healthcare and hospital utilization review work.

Depending on the employer, you may work with:

Candidates should be comfortable learning multiple healthcare technology platforms and coordinating with hospital teams in a fast-paced review environment.

Because member information is involved, candidates should have an appropriate professional environment for confidential healthcare communication and documentation.

Licensure & State Eligibility

Concurrent review roles are currently in highest demand in states with large hospital networks, major health plan headquarters, and busy inpatient utilization:

Top markets (major hospital systems + payer HQs): California, Texas, Florida, New York, Pennsylvania, Ohio, Illinois, Michigan, Georgia, North Carolina, Tennessee, Arizona.

Strong secondary markets: Colorado, Connecticut, Indiana, Kentucky, Maryland, Massachusetts, Minnesota, Missouri, New Jersey, Virginia, Washington, Wisconsin.

Also eligible: All other states where the employer operates, subject to state-specific licensure rules.

Applicants with an active LPN or LVN license, or an eligible multistate compact license, may apply. Final eligibility depends on the states in which the employer's members are located, the employer's requirements, and the licensing rules applicable to the specific position.

Learn how UR fits into the broader remote nursing landscape: read our how to become a remote LPN guide.

Compensation & Benefits

This position offers $28–$42 per hour, based on experience, geographic location, clinical background, and assignment requirements. Concurrent review roles typically pay slightly higher than other UR sub-specialties due to the acute care expertise required and the real-time regulatory demands of the work.

Benefits are assignment-specific and may vary depending on whether the opportunity is full-time, part-time, contract, or direct hire. Depending on the employer, benefits may include:

Eligibility, waiting periods, and specific benefit terms are confirmed with the employer during the offer stage.

Why Consider Remote Concurrent Review Nursing?

Concurrent review is one of the higher-paying remote nursing specialties — and one of the most clinically engaging — because it keeps you directly connected to acute care decision-making while removing the physical demands of the hospital floor.

Many nurses find concurrent review appealing because it offers:

• Continued clinical engagement — you're working with real-time hospital cases, not archival records.
• Hospital-aligned weekday schedule with no overnight shifts or weekend rotations.
• Strong employer demand — every hospital and health plan runs concurrent review.
• Career pathway into utilization management leadership, hospital UR, or managed care operations.
• Higher-than-average remote nursing pay due to the acute care expertise required.

It may be particularly suitable for LVNs with acute care or hospital experience who enjoy clinical review, real-time coordination, and structured criteria application.