Utilization Review Nurse
Fusion HCR•Las Vegas, NV
•Onsite
About The Position
Fusion HCR is hiring a Direct Hire Utilization Review Nurse for an onsite position, working with their client in Acute Care. This role involves reviewing patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. The Utilization Review Nurse will work closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Requirements
- Active RN license (Nevada)
- 5+ years acute care nursing experience
- 3+ years Utilization Review experience
- 3+ years discharge planning experience (acute care)
- Experience with InterQual (must be able to pass exam)
Nice To Haves
- Experience with Milliman guidelines
- Background in Case Management or CDI
- Strong knowledge of Joint Commission and CMS guidelines
Responsibilities
- Review admissions using InterQual and/or Milliman criteria
- Evaluate medical necessity, level of care, and documentation accuracy
- Ensure compliance with Medicare, Medicaid, and regulatory guidelines
- Collaborate with physicians, case management, and care teams
- Support discharge planning and care coordination
- Document findings and communicate recommendations
Benefits
- Competitive pay
- Stable, high-demand role
- Collaborative healthcare environment
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What This Job Offers
Job Type
Full-time
Career Level
Senior
