What are the responsibilities and job description for the RN Utilization Review position at Elios Healthcare?
Utilization Review Nurse
A major Nevada-based hospital system is hiring a Utilization Review Nurse to join a complex, high-volume clinical environment. This is a detail-driven role that sits at the intersection of clinical judgment and compliance, where your ability to interpret charts, apply utilization criteria, and communicate findings clearly will directly impact patient care and resource management.
What you need to bring:
- Graduate of an accredited nursing school
- Valid Nevada RN license
- Minimum five years of acute hospital clinical nursing experience
- Minimum three years of Utilization Management experience
- Minimum one year in Utilization Management, Case Management, or Clinical Documentation Improvement
- Minimum three years of discharge planning experience in an acute care facility
- Recent, documented experience with InterQual (ability to pass the InterQual exam required)
- Recent, documented experience with Milliman
- Working knowledge of Medicare and Medicaid guidelines, Joint Commission standards, and state statutes governing hospital services
What the role demands:
- Sharp chart interpretation skills with the ability to assess whether care aligns with best practice, diagnosis, and documentation standards
- Comfort navigating payer requirements and third-party compliance
- Strong written and verbal communication across clinical and administrative teams
- Ability to analyze data, write technical reports, and translate regulatory standards for a broad audience
Why it's worth a look:
- Clinically substantive role with real scope and visibility
- Large, well-resourced facility in Nevada
- Competitive compensation
If you're an experienced UR nurse with InterQual and Milliman credentials and a track record in acute care, let's talk.
Salary : $40 - $63