Utilization Review Nurse | Up to $63/hr + Pension Benefits

Title: Utilization Review Nurse (RN)
Department: Case Management
Job Type: Full-Time

Facility Details

• Academic Medical Center
• Nevada’s:
• • Level I Trauma Center
  • Verified Burn Center
  • Transplant Center
• First & only Magnet®-Recognized hospital in Nevada
• Major tertiary care hospital serving Southern Nevada

Pay & Benefits

• Hourly Pay: $40 – $63/hour
• Employer-paid Nevada PERS pension
• Competitive health & retirement benefits
• No state income tax in Nevada

Position Summary

The Utilization Review Nurse evaluates patient admissions and hospital stays to ensure:

• Medical necessity
• Appropriate level of care
• Efficient resource utilization
• Compliance with insurance/payer requirements

Main duties:

• Review medical records/charts
• Apply InterQual & Milliman criteria
• Coordinate with physicians/case managers
• Ensure accurate documentation
• Support discharge planning and utilization management
• Verify compliance with Medicare/Medicaid guidelines

Requirements

Education

• Graduate of accredited nursing school

Experience

Required:

• 5 years acute-care clinical RN experience
• Minimum 1 year in:
• • Utilization Management
  • Case Management
  • Clinical Documentation Improvement (CDI)
• 3+ years Utilization Management experience
• 3+ years discharge planning experience in acute care
• Experience with:
• • InterQual
  • Milliman guidelines

Must be able to pass InterQual exam.

License & Certifications

Required:

• Active Nevada RN license

~SK

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