Clinical Documentation & Utilization Specialist

The Valley Health System; Paradise (NV); On-site; USD 90,000 - 115,000; Full time

Benefits offered by this job

Education & training

Competitive pay

Paid time off

Medical benefits

Dental benefits

Vision benefits

401K with match

Stock plan

Career growth

Challenging environment

Job summary

The Valley Health System is seeking a Registered Nurse reviewer to perform concurrent and retrospective reviews of inpatient medical records in Southern Nevada. This role ensures documentation supports patient severity, risk of mortality, and compliant reimbursement for acute care services.

You will collaborate with clinical staff, adhere to payer and regulatory requirements, and contribute to reporting quality of care outcomes while maintaining high professional standards and accuracy.

Qualifications

• Education: Associates or Bachelors Degree in Nursing or International Medical Graduate.
• Experience: Minimum 5 years of clinical experience in an acute care setting; critical care, medical/surgical or Emergency Department nursing preferred.
• Technical Skills: Computer proficiency to include word processing, databases, and spreadsheets.
• License/Certification: Current RN license in the state of practice; strong written and verbal communication and critical thinking skills.

Responsibilities

• Provides concurrent and retrospective review of inpatient medical records to evaluate utilization and documentation.
• Ensures physician documentation reflects severity of illness and risk of mortality.
• Supports accurate reimbursement and reporting of care outcomes.
• Complies with external payers and regulatory requirements.

Skills

Critical thinking

Written communication

Verbal communication

Communication skills

Computer proficiency

Education

Associates or Bachelors in Nursing

International Medical Graduate

Tools

Word processing

Databases

Spreadsheets

Job description

The Valley Health System is seeking a Registered Nurse reviewer to perform concurrent and retrospective reviews of inpatient medical records in Southern Nevada. This role ensures documentation supports patient severity, risk of mortality, and compliant reimbursement for acute care services.

You will collaborate with clinical staff, adhere to payer and regulatory requirements, and contribute to reporting quality of care outcomes while maintaining high professional standards and accuracy.