Utilization Review Nurse

Fusion HCR

Fusion HCR is hiring! Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.

Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.

Responsibilities

Review admissions using InterQual and/or Milliman criteria
Evaluate medical necessity, level of care, and documentation accuracy
Ensure compliance with Medicare, Medicaid, and regulatory guidelines
Collaborate with physicians, case management, and care teams
Support discharge planning and care coordination
Document findings and communicate recommendations

Requirements

Active RN license (Nevada)
5+ years acute care nursing experience
3+ years Utilization Review experience
3+ years discharge planning experience (acute care)
Experience with InterQual (must be able to pass exam)
Experience with Milliman guidelines

Preferred

Background in Case Management or CDI
Strong knowledge of Joint Commission and CMS guidelines

Why Apply

Competitive pay
Stable, high-demand role
Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience , we want to hear from you!

Apply

Vacancy posted 4 days ago

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