Utilization Review Nurse

$40 - $63 per hour

Access Healthcare Staffing & Recruitment

Las Vegas, NV

Job Description

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

Apply

Vacancy posted 6 days ago

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