RN Utilization Review Nurse – Magnet NV Center

Lancesoft; Nevada; On-site; USD 55,000 - 87,000; Full time

Benefits offered by this job

Employer-paid Nevada PERS pension

No state income tax in Nevada

Job summary

LanceSoft is seeking an Utilization Review Nurse (RN) for a full-time role in Nevada. The position requires evaluating admissions and hospital stays for medical necessity, appropriate level of care, and resource utilization.

Responsibilities include reviewing records, applying InterQual and Milliman criteria, coordinating with physicians and case managers, and ensuring proper documentation and discharge planning.

Qualifications

• Graduate of accredited nursing school.
• 5 years acute-care clinical RN experience.
• Minimum 1 year in Utilization Management.
• 3+ years Utilization Management experience.
• 3+ years discharge planning experience in acute care.
• Experience with InterQual/Milliman guidelines.

Responsibilities

• Review medical records/charts.
• Apply InterQual & Milliman criteria.
• Coordinate with physicians/case managers.
• Ensure accurate documentation.
• Support discharge planning and utilization management.
• Verify compliance with Medicare/Medicaid guidelines.

Skills

Acute-care RN

Utilization Management

Case Management

Discharge Planning

Education

Graduate of accredited nursing school

Tools

InterQual

Milliman guidelines

Job description

LanceSoft is seeking an Utilization Review Nurse (RN) for a full-time role in Nevada. The position requires evaluating admissions and hospital stays for medical necessity, appropriate level of care, and resource utilization.

Responsibilities include reviewing records, applying InterQual and Milliman criteria, coordinating with physicians and case managers, and ensuring proper documentation and discharge planning.