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