Local Contract Nurse RN - Utilization Review
Las Vegas, NV
LanceSoft
5x8 hrs, Days, Nights, Flexible

Job Title: Utilization Review Nurse (RN)

Location: Las Vegas, Nevada
Job Type: Full-Time
Salary: $40.72 – $63.12 per hour

Position Summary:

We are seeking an experienced Utilization Review Nurse (RN) to join a healthcare team in Las Vegas, Nevada. This role is responsible for evaluating patient admissions, ensuring appropriate utilization of healthcare resources, and maintaining compliance with payer guidelines and regulatory standards.

Key Responsibilities:

• Review patient admissions for medical necessity and appropriateness
• Evaluate efficiency of resource utilization
• Ensure compliance with third-party payer requirements
• Analyze medical records and clinical documentation
• Apply InterQual and/or Milliman criteria for case review
• Collaborate with care teams on discharge planning and case management
• Prepare reports and communicate findings effectively

Requirements:

Education & Experience:

• Graduate of an accredited nursing program
• Minimum 5 years of acute care clinical nursing experience
• At least 1 year in Utilization Management, Case Management, or Clinical Documentation Improvement

Licensure & Certification:

• Active or eligible Registered Nurse (RN) license in the State of Nevada

Additional Requirements:

• Minimum 3 years of Utilization Management experience
• Minimum 3 years of discharge planning experience in an acute care setting
• Recent experience with InterQual and ability to pass the InterQual exam
• Experience with Milliman criteria

Skills & Competencies:

• Strong knowledge of utilization review criteria (InterQual/Milliman)
• Understanding of Medicare, Medicaid, and regulatory guidelines
• Ability to interpret clinical data and patient charts
• Strong analytical, documentation, and reporting skills
• Excellent communication and collaboration abilities
• Proficiency with computers and healthcare software systems

Work Environment & Physical Requirements:

• Office/clinical setting with extended periods of sitting
• Ability to review detailed documentation on computer screens
• Effective verbal and written communication skills
• May require flexibility for shifts or weekends

Compensation & Benefits:

• Competitive hourly pay
• Comprehensive benefits package
• Employer-paid pension plan
• Stable, full-time opportunity with growth potential