Utilization Review Nurse (RN) - $42-$65/hr + Sign-On Bonus

Utilization Review Nurse
Location: Las Vegas, NV
Job Type: Full-Time
Pay: $42–$65/hr + Sign-On Bonus

Job Summary

Review patient admissions and continued stays to ensure medical necessity, appropriate resource utilization, and compliance with payer and regulatory requirements.

Responsibilities

• Review admissions and continued stays for medical necessity.
• Apply InterQual and/or Milliman (MCG) criteria.
• Collaborate with physicians, case managers, and healthcare teams.
• Support discharge planning and care coordination.
• Maintain accurate documentation and regulatory compliance.

Qualifications

• Graduate of an accredited School of Nursing.
• Current RN license in the applicable state.
• 5+ years of acute care nursing experience.
• 1+ year of Utilization Management, Case Management, or Clinical Documentation Improvement experience.
  

Preferred Qualifications

• 3+ years of Utilization Management experience.
• 3+ years of discharge planning experience in an acute care setting.
• Recent experience with InterQual and Milliman (MCG) guidelines.
• Knowledge of Medicare, Medicaid, and commercial payer requirements.
  

Skills

• Strong clinical assessment, communication, analytical, and documentation skills.
  
  

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