Location & Practice Overview

Integra Partners is hiring a Nurse Care Management LPN (Virtual) for a fully remote position advertised in Philadelphia, Pennsylvania. The role is part of the company's national utilization management operations, supporting healthcare plans and their participating DMEPOS provider networks. Rather than working in a hospital or outpatient clinic, the nurse performs documentation-based reviews within a managed-care environment.

Practice Setting Remote healthcare utilization management
Department Utilization Management
Specialty Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
Organization National healthcare network management company
Advertised Location Philadelphia, PA (fully remote)

Responsibilities

  • Perform pre-service and post-service utilization reviews of DMEPOS authorization requests.
  • Assess clinical records against federal and state regulations, health-plan benefits, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and medical necessity requirements.
  • Approve requests that satisfy applicable eligibility, coverage, and medical necessity criteria, referring cases outside the LPN's review authority to the Medical Director.
  • Review administrative and clinical appeals and coordinate referrals for physician or independent review when necessary.
  • Document review findings and communicate authorization decisions clearly through written and verbal channels.

The nurse also works with non-clinical team members to obtain missing records and ensure that each case contains the information needed for a complete review. Accurate documentation and consistent application of coverage requirements are essential throughout the authorization and appeals process.

Qualifications & Requirements

Applicants must hold an active LPN or LVN license and meet the required clinical nursing and utilization management experience thresholds. Previous work in a managed-care or healthcare payer environment is essential.

Required License
Active Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) license
Clinical Experience
At least 3 years of nursing experience in an acute-care or outpatient setting
Utilization Management Experience
At least 2 years of UM experience in a managed-care or healthcare payer environment
Clinical Criteria Knowledge
Experience applying InterQual, CMS guidelines, and health-plan medical policies
Preferred Experience
Medicare or Medicaid programs, DMEPOS authorizations and appeals, and preparation of medical necessity denial letters

Compensation & Benefits

The position offers a base annual salary of $60,000, with eligibility for an annual bonus program. The benefits package includes retirement savings, health insurance, paid leave, and additional employee protections.

  • Annual base salary of $60,000
  • Eligibility for an annual bonus program
  • 401(k) retirement plan with company match
  • Company-paid life insurance and short-term disability coverage, subject to location restrictions
  • Medical, dental, and vision insurance
  • Paid time off, sick time, paid parental leave, company holidays, and floating holidays

Schedule & Work Environment

Employment Type Full-time
Work Arrangement Fully remote / virtual
Work Environment Remote managed-care operations and clinical documentation review
Eligible States PA, AZ, CO, CT, FL, GA, ID, IL, KY, MA, MI, NC, NV, NJ, NY, OH, SC, TN, TX, VA, and WA

Patient Population & Clinical Setting

The position supports members enrolled in commercial, Medicare, Medicaid, and other health-plan arrangements who require coverage for medically necessary equipment and related supplies. Clinical information is evaluated through submitted records and authorization documentation rather than in-person assessments or bedside encounters.

Member Population Commercial, Medicare, Medicaid, and other health-plan members
Covered Services Durable medical equipment, prosthetics, orthotics, and related supplies
Clinical Interaction Review of submitted medical records and supporting clinical documentation
Care Delivery Model Health-plan coverage administration and managed-care review

Clinical Focus & Key Services

The clinical specialty is DMEPOS utilization management, with an emphasis on determining whether requested equipment and supplies meet applicable medical necessity and coverage standards.

Primary Specialty DMEPOS medical necessity assessment
Coverage Standards National Coverage Determinations, Local Coverage Determinations, and health-plan medical policies
Review Categories Pre-service, post-service, administrative, and clinical appeal reviews
Decision Framework InterQual criteria, CMS guidelines, and applicable plan-specific requirements

Role Highlights

This opportunity offers experienced LPNs and LVNs a transition into a specialized non-bedside nursing career, combining clinical judgment, coverage analysis, and healthcare administration.

  • Full-time remote position with a $60,000 annual base salary and bonus eligibility.
  • Specialized nursing work involving DMEPOS coverage decisions and utilization review.
  • Professional collaboration with a Medical Director and independent review organizations on cases requiring additional evaluation.
  • Opportunity to work within an NCQA-accredited utilization management program.

About Integra Partners

Founded in 2005, Integra Partners is a healthcare network management company specializing in durable medical equipment, prosthetics, orthotics, and related medical supplies. The organization connects health plans with participating DMEPOS providers and supports network administration and benefit management. Its services include utilization management for commercial, Medicare, Medicaid, and other healthcare programs. Integra Partners maintains its primary location in Michigan and supports a remote workforce across multiple states. Its utilization management program holds NCQA accreditation.

Organization Type Healthcare network management company
Founded 2005
Core Services DMEPOS provider network administration, benefit management, and utilization management
Accreditation NCQA-accredited utilization management program
Primary Location Michigan

Frequently Asked Questions

Is this a traditional bedside LPN position?
No. This is a remote utilization management position focused on reviewing clinical documentation, evaluating medical necessity, and assessing DMEPOS coverage requests.
What happens when a request does not meet medical necessity criteria?
Cases that do not meet applicable criteria are referred to the Medical Director for further clinical evaluation. Certain appeals may also require review by independent consultants or Independent Review Organizations.
Is experience writing medical necessity denial letters required?
No. Experience preparing medical necessity denial letters is preferred, but it is not listed as a mandatory qualification.
Which guidelines are used for utilization reviews?
Reviews use applicable federal and state requirements, National and Local Coverage Determinations, health-plan benefit provisions, InterQual criteria, CMS guidelines, and plan-specific medical policies.
Is previous DMEPOS utilization management experience mandatory?
No. Direct DMEPOS authorization and appeals experience is preferred. However, at least two years of utilization management experience in a managed-care or healthcare payer environment is required.
How are missing clinical records obtained?
The nurse collaborates with non-clinical team members to request and collect missing clinical documentation needed to complete the review.

Remote Utilization Management LPN Nurse – Philadelphia, PA

Integra Partners is hiring a Nurse Care Management LPN (Virtual) in Philadelphia, PA, for specialized DMEPOS utilization management. The remote nurse evaluates equipment authorization requests, reviews clinical records, and processes appeals using applicable coverage and medical necessity guidelines. Applicants need an active LPN or LVN license, three years of acute-care or outpatient nursing experience, and two years of managed-care or payer-based utilization management experience. Medicare, Medicaid, and DMEPOS experience are preferred. The full-time position offers a $60,000 annual base salary, bonus eligibility, and medical, dental, vision, and retirement benefits.

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