Utilization Review Nurse
Access Healthcare Staffing & Recruitment•Las Vegas, NV
•Onsite
About The Position
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.
Requirements
- 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
- Active Nevada RN license
- Experience with InterQual (must be able to pass exam)
- Experience with Milliman criteria
- 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
Responsibilities
- Reviews patient admissions for medical necessity
- Reviews patient admissions for appropriate resource utilization
- Reviews patient admissions for compliance with payer guidelines
- Analyzes medical records to ensure care meets established clinical and regulatory standards
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
1-10 employees
