What are the responsibilities and job description for the Utilization Review Nurse position at Access Healthcare Staffing and Recruitment Inc.?
Utilization Review Nurse (RN)
Las Vegas, NV | Full-Time
Salary: $40 – $63/hour
Position Summary
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:
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
Salary : $40 - $63