Senior Utilization Review RN – Acute Care, Sign-On Bonus

Lancesoft; Nevada; On-site; USD 59,000 - 87,000; Full time

Benefits offered by this job

Sign-On Bonus up to $15,000

Job summary

LanceSoft is seeking an Utilization Review Nurse in Nevada to evaluate patient admissions for medical necessity and payer compliance in an acute care setting. You will review clinical documentation and collaborate with case management to support quality standards and regulatory compliance.

The role requires 5+ years in acute care nursing, including Utilization Management, Case Management, or CDI, with active Nevada RN licensure. Experience with InterQual and Milliman criteria is essential.

Qualifications

• Graduate of an accredited nursing program.
• Minimum 5 years of acute care clinical nursing experience, including at least 1 year in Utilization Management, Case Management, or Clinical Documentation Improvement.
• Active Nevada RN license required.
• Minimum 3 years of Utilization Management experience.
• Minimum 3 years of discharge planning experience in an acute care setting.
• Recent hands-on experience with InterQual and ability to successfully pass the InterQual exam.
• Recent experience utilizing Milliman criteria required.

Responsibilities

• Review patient admissions for medical necessity and payer compliance.
• Evaluate clinical documentation to ensure appropriate resource utilization.
• Collaborate with case management and discharge planning teams.
• Utilize InterQual and Milliman criteria during utilization review processes.
• Accurately document findings and communicate review determinations.
• Maintain current knowledge of regulatory and compliance standards.
• Support clinical documentation improvement initiatives.

Skills

Acute care nursing

Utilization management

Discharge planning

Clinical documentation improvement

Education

RN license (Registered Nurse)

Tools

InterQual

Milliman criteria

Job description

LanceSoft is seeking an Utilization Review Nurse in Nevada to evaluate patient admissions for medical necessity and payer compliance in an acute care setting. You will review clinical documentation and collaborate with case management to support quality standards and regulatory compliance.

The role requires 5+ years in acute care nursing, including Utilization Management, Case Management, or CDI, with active Nevada RN licensure. Experience with InterQual and Milliman criteria is essential.