Utilization Review Nurse | Up to $63/hr + Pension Benefits

Lancesoft INC; Nevada; On-site; USD 55,000 - 87,000; Full time

Benefits offered by this job

Employer-paid Nevada PERS pension

No state income tax in Nevada

Job summary

LanceSoft is seeking an Utilization Review Nurse (RN) for a full-time role in Nevada. The position requires evaluating admissions and hospital stays for medical necessity, appropriate level of care, and resource utilization.

Responsibilities include reviewing records, applying InterQual and Milliman criteria, coordinating with physicians and case managers, and ensuring proper documentation and discharge planning.

Qualifications

• Graduate of accredited nursing school.
• 5 years acute-care clinical RN experience.
• Minimum 1 year in Utilization Management.
• 3+ years Utilization Management experience.
• 3+ years discharge planning experience in acute care.
• Experience with InterQual/Milliman guidelines.

Responsibilities

• Review medical records/charts.
• Apply InterQual & Milliman criteria.
• Coordinate with physicians/case managers.
• Ensure accurate documentation.
• Support discharge planning and utilization management.
• Verify compliance with Medicare/Medicaid guidelines.

Skills

Acute-care RN

Utilization Management

Case Management

Discharge Planning

Education

Graduate of accredited nursing school

Tools

InterQual

Milliman guidelines

Job description

Job Description

Title: Utilization Review Nurse (RN)
Department: Case Management
Job Type: Full-Time

Facility Details

• Academic Medical Center
• Nevadas:
• • Level I Trauma Center
  • Verified Burn Center
  • Transplant Center
• First & only Magnet-Recognized hospital in Nevada
• Major tertiary care hospital serving Southern Nevada

Pay & Benefits

• Hourly Pay: $40 – $63/hour
• Employer-paid Nevada PERS pension
• Competitive health & retirement benefits
• No state income tax in Nevada

Position Summary

The Utilization Review Nurse evaluates patient admissions and hospital stays to ensure:

• Medical necessity
• Appropriate level of care
• Efficient resource utilization
• Compliance with insurance/payer requirements

Main duties:

• Review medical records/charts
• Apply InterQual & Milliman criteria
• Coordinate with physicians/case managers
• Ensure accurate documentation
• Support discharge planning and utilization management
• Verify compliance with Medicare/Medicaid guidelines

Requirements

Education

• Graduate of accredited nursing school

Experience

Required:

• 5 years acute-care clinical RN experience
• Minimum 1 year in:
• • Utilization Management
  • Case Management
  • Clinical Documentation Improvement (CDI)
• 3+ years Utilization Management experience
• 3+ years discharge planning experience in acute care
• Experience with:
• • InterQual
  • Milliman guidelines

Must be able to pass InterQual exam.

License & Certifications

Required:

• Active Nevada RN license

~SK

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.

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.