Utilization Review Nurse | $15K Sign on | Urgent Hiring

Lancesoft INC; Nevada; On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

LanceSoft is seeking a Utilization Review Nurse to assess patient admissions, ensure medical necessity, and optimize resource use in acute care settings. This role collaborates with case management teams to support payer requirements and quality standards.

Requirements include Nevada RN license, 5 years of acute hospital nursing with at least 1 year in UM/CM/CDI, and experience with InterQual and Milliman criteria. A $15K sign-on bonus is eligible.

Qualifications

• Graduate from accredited school of nursing with 5 years acute hospital nursing, including 1 year in UM/CM/CDI.
• Nevada RN license required.
• At least 3 years Utilization Management experience.
• At least 3 years discharge planning in an acute care facility.
• Recent InterQual experience with ability to pass the InterQual exam.
• Recent Milliman experience.

Responsibilities

• Review patient admissions for medical necessity and payer guidelines.
• Analyze clinical documentation to verify resource utilization.
• Collaborate with case management and discharge planning teams.
• Apply InterQual and Milliman criteria in utilization review processes.
• Document findings and communicate review outcomes effectively.
• Maintain up-to-date knowledge of regulatory compliance standards.
• Support clinical documentation improvement initiatives.

Skills

Utilization Management

Case Management

Discharge Planning

Clinical Documentation Improvement

InterQual

Milliman

Education

Registered Nurse license (Nevada)

Tools

InterQual criteria

Milliman criteria

Job description

Job Description

The Utilization Review Nurse plays a critical role in assessing patient admissions to ensure appropriate care, resource efficiency, and adherence to third-party payer requirements. This position involves detailed analysis of medical charts and collaboration with case management teams to support compliance and quality standards within acute care settings.

Responsibilities

• Review patient admissions for medical necessity and compliance with payer guidelines
• Analyze clinical documentation to verify appropriate resource utilization
• Collaborate closely with case management and discharge planning teams
• Apply InterQual and Milliman criteria in utilization review processes
• Document findings and communicate review outcomes effectively
• Maintain up-to-date knowledge of regulatory compliance standards
• Support clinical documentation improvement initiatives

Required Qualifications

• Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.
• Valid license by the State of Nevada to practice as a Registered Nurse.
• Minimum three (3) years of Utilization Management experience.
• Minimum of three (3) year's experience with discharge planning in an acute care facility.
• Recent documented experience with InterQual, and ability to pass the InterQual exam.
• Recent documented experience with Milliman experience.

$15K Sign On bonus eligible

Company Description

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.