Utilization Review Nurse

Access Healthcare Staffing & Recruitment; Las Vegas (NV); On-site; USD 55,000 - 87,000; Full time

Job summary

Access Healthcare Staffing & Recruitment is seeking an experienced Utilization Review Nurse (RN) in Las Vegas, NV. The role focuses on reviewing admissions for medical necessity and ensuring resource utilization aligns with payer guidelines.

The position requires an accredited nursing degree, 5+ years in acute care, and at least 1 year in Utilization Management, Case Management, or CDI, plus 3+ years in Utilization Management and discharge planning in acute care.

Qualifications

• 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.

Responsibilities

• Reviews patient admissions for medical necessity and resource utilization.
• Analyzes medical records to ensure care meets clinical and regulatory standards.

Skills

Utilization review

InterQual

Milliman criteria

Chart review

Regulatory compliance

Communication

Analytical skills

Education

Accredited nursing program

5+ years acute care nursing

1 year in Utilization Management/Case Management/CDI

3+ years Utilization Management

3+ years discharge planning in acute care

Tools

InterQual

Milliman criteria

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