Utilization Review Nurse — Sign-On Bonus Eligible

Lancesoft; 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

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.