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*Featured Job* Utilization Review Nurse
Utilization Review Nurse (RN)
Las Vegas, NV | Full-Time
Salary: $40 – $63/hour
Position Summary
Reviews patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Analyzes medical records to ensure care meets established clinical and regulatory standards.
Requirements:
Education/Experience:
Graduate of an accredited nursing program
5+ years of acute care nursing experience
At least 1 year in Utilization Management, Case Management, or CDI
Minimum 3 years of Utilization Management experience
3+ years of discharge planning experience in acute care
Licensure:
Active Nevada RN license
Additional Requirements:
Experience with InterQual (must be able to pass exam)
Experience with Milliman criteria
Key Skills & Knowledge
Utilization review criteria (InterQual/Milliman), Medicare/Medicaid guidelines
Chart review and clinical documentation analysis
Regulatory compliance and hospital standards
Strong communication, collaboration, and analytical skills
Work Environment
Office-based with extended sitting and computer use
May require shifts and weekends
To learn more, call us at 702-597-1758