Access Healthcare Staffing & Recruitment
Location
Las Vegas, Nevada
Salary
$40 - $63 / HOUR
The Utilization Review Nurse evaluates patient admissions to ensure medical necessity and appropriate resource utilization. They analyze medical records to verify that care aligns with established clinical and regulatory standards.
Candidates must be graduates of an accredited nursing program with an active Nevada RN license. The role requires at least 5 years of acute care experience and specific proficiency in utilization management criteria like InterQual and Milliman.
Utilization Review Nurse (RN) Las Vegas, NV | Full-Time Salary: $40 – $63/hour
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.
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
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