Utilization Review Nurse

Fusion HCR; Las Vegas (NV); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Competitive pay

Stable, high-demand role

Collaborative healthcare environment

Job summary

A healthcare provider is hiring a Utilization Review Nurse for an on-site position in Las Vegas, Nevada. This role involves reviewing patient admissions for medical necessity and ensuring compliance with payer guidelines. Candidates should have an active RN license in Nevada, over 5 years of acute care nursing experience, and at least 3 years in Utilization Review. The position offers competitive pay and a collaborative healthcare environment.

Qualifications

• 5+ years acute care nursing experience.
• 3+ years Utilization Review experience.
• 3+ years discharge planning experience (acute care).

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.

Skills

Utilization Review

InterQual

Acute Care Nursing

Documentation Accuracy

Discharge Planning

Education

Active RN license (Nevada)

Tools

Milliman Guidelines

Job description

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!