Utilization Review RN — Per Diem Chart Review Specialist

Carson Valley Heath; Gardnerville (NV); On-site; USD 83,000 - 103,000; Part time

Job summary

Carson Valley Health in Nevada is seeking a Utilization Review RN for per diem coverage. The role focuses on chart reviews to ensure InterQual-based criteria are met, coordinating with payors and hospital departments to maximize reimbursement and support medical necessity documentation.

The position requires Nevada RN licensure, 1 year of case management or utilization management experience, and familiarity with InterQual or McKesson criteria. Per diem terms include an enhanced hourly rate.

Qualifications

• RN with active Nevada license and in good standing; 1 year of case management or utilization management experience preferred.
• Bachelor's degree in nursing preferred; 3+ years clinical care or nursing experience or equivalent combination with 2 years Utilization Review experience.

Responsibilities

• Conducts chart reviews to verify InterQual-based care criteria.
• Assist in determining appropriate hospital setting and review elective surgeries and outpatient charts.
• Obtain patient records as required and coordinate UR with Medical Director as needed.
• Maximize hospital reimbursement and obtain necessary authorizations; follow up with payors.
• Review denials and assist in appeals; collaborate with HIM/coding staff to ensure accurate documentation.
• Communicate with hospital departments to ensure timely and accurate information flow.

Skills

Communication skills

Independent worker

InterQual criteria knowledge

Medical record review

ICD-10/CPT knowledge

Regulatory knowledge

PC proficiency

Education

Bachelor's Degree in Nursing

CCM certification (preferred)

Job description

Carson Valley Health in Nevada is seeking a Utilization Review RN for per diem coverage. The role focuses on chart reviews to ensure InterQual-based criteria are met, coordinating with payors and hospital departments to maximize reimbursement and support medical necessity documentation.

The position requires Nevada RN licensure, 1 year of case management or utilization management experience, and familiarity with InterQual or McKesson criteria. Per diem terms include an enhanced hourly rate.